MEDICARE: RAPHAX HOME HEALTHCARE LLC

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	:	1699638429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPHAX HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1522 SHADOW LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 SHADOW LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5024
Country	:	US
Telephone Number	:	314-755-5894
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ALEXANDER OLISA
Credential	:
Telephone Number	:	314-755-5894

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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