MEDICARE: GAVIN'S HEATHCARE MANAGEMENT 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	:	1831747823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAVIN'S HEATHCARE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	1846 N 18TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3100
Country	:	US
Telephone Number	:	314-445-7280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1846 N 18TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3100
Country	:	US
Telephone Number	:	314-445-7280
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TENIKA ZASARETTI
Credential	:
Telephone Number	:	314-445-7280

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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