1083110647 NPI number — SPECIALTY HOME HEALTHCARE INC.

Table of content: (NPI 1083110647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083110647 NPI number — SPECIALTY HOME HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY HOME HEALTHCARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083110647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 410181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CREVE COEUR
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-0181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-712-6170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2012 WOODSON RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63114-5644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-222-9521
Provider Business Practice Location Address Fax Number:
636-220-8379
Provider Enumeration Date:
04/03/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
LONNIKAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
314-368-4207

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)