Provider Demographics
NPI:1083668289
Name:1-ON-1 HOME CARE LLC
Entity Type:Organization
Organization Name:1-ON-1 HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRICKEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-436-4413
Mailing Address - Street 1:10419 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1695
Mailing Address - Country:US
Mailing Address - Phone:573-436-4413
Mailing Address - Fax:573-436-9039
Practice Address - Street 1:10419 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1695
Practice Address - Country:US
Practice Address - Phone:573-436-4413
Practice Address - Fax:573-436-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0007665Medicaid