Provider Demographics
NPI:1093794141
Name:BABY BOOMERS HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:BABY BOOMERS HOME HEALTH SERVICES, INC
Other - Org Name:A BETTER WAY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-391-5353
Mailing Address - Street 1:15332 MANCHESTER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3072
Mailing Address - Country:US
Mailing Address - Phone:636-391-5353
Mailing Address - Fax:636-391-8051
Practice Address - Street 1:15332 MANCHESTER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-3072
Practice Address - Country:US
Practice Address - Phone:636-391-5353
Practice Address - Fax:636-391-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO778251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO586250904Medicaid
MO267601Medicare PIN