MEDICARE: PSG HOME HEALTH CARE 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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891337911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSG HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	4009 7 HILLS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6737
Country	:	US
Telephone Number	:	314-838-9500
Fax Number	:	314-828-8137

Provider Business Practice Location Address
First Line	:	4009 7 HILLS DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-6737
Country	:	US
Telephone Number	:	314-838-9500
Fax Number	:	314-828-8137

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	DR. FOLAHAN PHILIP OLISHILE
Credential	:
Telephone Number	:	314-838-9500

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/28/2022

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