MEDICARE: THE HOME TEAM HOME HEALTH SERVICES & ADULT DAYCARE 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	:	1821207358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HOME TEAM HOME HEALTH SERVICES & ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	6600 PENNSYLVANIA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-2903
Country	:	US
Telephone Number	:	314-922-3208
Fax Number	:	314-448-1891

Provider Business Practice Location Address
First Line	:	6407 MICHIGAN AVE OFC
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-2802
Country	:	US
Telephone Number	:	314-922-3208
Fax Number	:	314-448-1891

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. SPARKS ANDERSON STONE
Credential	:	EMT-P
Telephone Number	:	314-922-3208

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/11/2008

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