Provider Demographics
NPI:1053983460
Name:BELLA MARIE HOME HEALTH AGENCY, LLC
Entity type:Organization
Organization Name:BELLA MARIE HOME HEALTH AGENCY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:314-873-2121
Mailing Address - Street 1:2200 N HIGHWAY 67 UNIT 2424
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63032-4053
Mailing Address - Country:US
Mailing Address - Phone:314-348-3907
Mailing Address - Fax:
Practice Address - Street 1:1515 N WARSON RD STE 217
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1115
Practice Address - Country:US
Practice Address - Phone:314-348-3907
Practice Address - Fax:314-453-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053983460Medicaid