MEDICARE: DECLARE IN-HOME HEALTH 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	251E00000X	Home Health Agency	LC001454786	MO

General Provider Information

NPI Number	:	1952752990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DECLARE IN-HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	3439 BROWN RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-4329
Country	:	US
Telephone Number	:	314-269-4096
Fax Number	:

Provider Business Practice Location Address
First Line	:	3439 BROWN RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-4329
Country	:	US
Telephone Number	:	314-269-4096
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHARRON MONIQUE DIXON
Credential	:
Telephone Number	:	314-269-4096

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	04/10/2020

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Directions to “DECLARE IN-HOME HEALTH CARE ” Practice Location

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