Provider Demographics
NPI:1003457425
Name:CARING HEARTS HOMECARE OF SOUTHEAST MISSOURI LLC
Entity Type:Organization
Organization Name:CARING HEARTS HOMECARE OF SOUTHEAST MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-624-9100
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0211
Mailing Address - Country:US
Mailing Address - Phone:573-624-9100
Mailing Address - Fax:573-624-9947
Practice Address - Street 1:507 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1707
Practice Address - Country:US
Practice Address - Phone:573-624-9100
Practice Address - Fax:573-624-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM285205407Medicaid