MEDICARE: ACCREDITED HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861145914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCREDITED HOME CARE

Provider Business Mailing Address
First Line	:	910 LILAC DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-3124
Country	:	US
Telephone Number	:	314-392-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 CRAIGSHIRE RD STE 410C
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4036
Country	:	US
Telephone Number	:	314-359-3630
Fax Number	:	314-485-1336

Authorized Official
Title or Position	:	OWNER
Name	:	LATRICE WESLEY
Credential	:
Telephone Number	:	314-392-1150

Provider Enumeration Date	:	01/29/2022
Last Update Date	:	07/26/2023

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Directions to “ACCREDITED HOME CARE ” Practice Location

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