| NPI | 1992241202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEQUILA DIONTA CLARK Owner 314-696-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: MO LC9819745) |
| Additional Taxonomies | 251E00000X Home Health (Licence: MO LC9819745) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-01-10 |