MEDICARE: MARK AND JULIE MANN 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	:	1992086003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK AND JULIE MANN LLC

Provider Business Mailing Address
First Line	:	111 W PORT PLZ
Second Line	:	6TH FLOOR, STE. 600
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3011
Country	:	US
Telephone Number	:	314-813-9505
Fax Number	:	314-584-2040

Provider Business Practice Location Address
First Line	:	111 W PORT PLZ
Second Line	:	6TH FLOOR, STE. 600
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3011
Country	:	US
Telephone Number	:	314-813-9505
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JULIE MANN
Credential	:	RN, BSN
Telephone Number	:	314-813-9505

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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