MEDICARE: SOC 4 HEALTH 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

General Provider Information

NPI Number	:	1952743460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOC 4 HEALTH LLC

Provider Business Mailing Address
First Line	:	1360 S 5TH ST STE 386
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2447
Country	:	US
Telephone Number	:	314-477-8125
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 S 5TH ST STE 386
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2447
Country	:	US
Telephone Number	:	314-477-8125
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. RAESHIA MARIA HAMPTON
Credential	:
Telephone Number	:	314-477-8125

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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