Provider Demographics
NPI:1053655456
Name:AT HOME CARE ST. LOUIS
Entity type:Organization
Organization Name:AT HOME CARE ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STROTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-739-2100
Mailing Address - Street 1:3460 FALCON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3126
Mailing Address - Country:US
Mailing Address - Phone:314-739-2100
Mailing Address - Fax:314-739-2101
Practice Address - Street 1:3460 FALCON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3126
Practice Address - Country:US
Practice Address - Phone:314-739-2100
Practice Address - Fax:314-739-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care