Provider Demographics
NPI:1053669689
Name:HOMEPOINTE HEALTHCARE OF MISSOURI LLC
Entity type:Organization
Organization Name:HOMEPOINTE HEALTHCARE OF MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-744-6145
Mailing Address - Street 1:8515 BLUFFTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-3022
Mailing Address - Country:US
Mailing Address - Phone:260-744-6145
Mailing Address - Fax:260-444-0006
Practice Address - Street 1:1215 FERN RIDGE PKWY
Practice Address - Street 2:STE 107
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-4401
Practice Address - Country:US
Practice Address - Phone:877-744-6145
Practice Address - Fax:260-444-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506259902Medicaid
MO506259902Medicaid