MEDICARE: DEER VALLEY HOME HEALTH SERVICES 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	LC0609431	MO

General Provider Information

NPI Number	:	1972081826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER VALLEY HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	8600 AIRPORT RD STE 104
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-1937
Country	:	US
Telephone Number	:	314-355-3679
Fax Number	:	314-521-5661

Provider Business Practice Location Address
First Line	:	8600 AIRPORT RD STE 104
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-1937
Country	:	US
Telephone Number	:	314-355-3679
Fax Number	:	314-521-5661

Authorized Official
Title or Position	:	OWNER
Name	:	ADA JOYCE TAYLOR
Credential	:
Telephone Number	:	314-355-3679

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	08/02/2018

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