1245804665 NPI number — YOUR PLACE HOME HEALTH CARE LLC

Table of content: ANNA LEIGHTON HASTINGS DMD (NPI 1033529037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245804665 NPI number — YOUR PLACE HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR PLACE HOME HEALTH CARE LLC
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:
1245804665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2151A GEYER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63104-2671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-456-5651
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4625 LINDELL BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63108-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-456-5651
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC DIRECTOR
Authorized Official Telephone Number:
314-456-5651

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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