1649651472 NPI number — OUR KINGS AND QUEENS HOME HEALTH LLC

Table of content: (NPI 1649651472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649651472 NPI number — OUR KINGS AND QUEENS HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUR KINGS AND QUEENS HOME HEALTH 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:
1649651472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S 4TH ST
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63102-1800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-797-5033
Provider Business Mailing Address Fax Number:
314-797-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63102-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-224-5544
Provider Business Practice Location Address Fax Number:
314-797-5001
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
JAOHN COOPER
Authorized Official Middle Name:
SHAMEEKA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/OWNER
Authorized Official Telephone Number:
314-709-6861

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X , with the licence number: LC9782201 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com