MEDICARE: NBA HEALTHCARE

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	21643369	MO

General Provider Information

NPI Number	:	1689925752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NBA HEALTHCARE

Provider Business Mailing Address
First Line	:	1811 SHERMAN DR
Second Line	:	SUITE 3
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3976
Country	:	US
Telephone Number	:	636-866-0722
Fax Number	:	636-866-0729

Provider Business Practice Location Address
First Line	:	1811 SHERMAN DR
Second Line	:	SUITE 3
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3976
Country	:	US
Telephone Number	:	636-866-0722
Fax Number	:	636-866-0729

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM H ALLEN
Credential	:
Telephone Number	:	636-866-0722

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	09/28/2012

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