MEDICARE: INDEPENDENT HOMECARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1689847840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT HOMECARE

Provider Business Mailing Address
First Line	:	10608 CROWLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2427
Country	:	US
Telephone Number	:	314-521-7777
Fax Number	:	314-521-7777

Provider Business Practice Location Address
First Line	:	10608 CROWLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2427
Country	:	US
Telephone Number	:	314-521-7777
Fax Number	:	314-521-7777

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MRS. ANNETTE PATRICE DINWIDDIE
Credential	:
Telephone Number	:	314-324-1260

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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