Provider Demographics
NPI:1033418306
Name:CORNING HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:CORNING HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SZU CHING
Authorized Official - Middle Name:
Authorized Official - Last Name:FU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-965-2780
Mailing Address - Street 1:111 PROSPECT AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6052
Mailing Address - Country:US
Mailing Address - Phone:314-965-2780
Mailing Address - Fax:314-965-2782
Practice Address - Street 1:111 PROSPECT AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6052
Practice Address - Country:US
Practice Address - Phone:314-965-2780
Practice Address - Fax:314-965-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO251E00000XMedicaid