MEDICARE: A BLESSED HEART, 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	:	1710386529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BLESSED HEART, LLC.

Provider Business Mailing Address
First Line	:	1607 KEELEN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2438
Country	:	US
Telephone Number	:	314-716-2373
Fax Number	:	314-716-3325

Provider Business Practice Location Address
First Line	:	1607 KEELEN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2438
Country	:	US
Telephone Number	:	314-716-2373
Fax Number	:	314-716-3325

Authorized Official
Title or Position	:	OWNER/DESIGNATED MANAGER
Name	:	MS. DOROTHY STEWART
Credential	:	RN
Telephone Number	:	314-716-2373

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	08/18/2014

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