Provider Demographics
NPI:1114699758
Name:EDENS SACRED HAND HOMECARE, LLC
Entity Type:Organization
Organization Name:EDENS SACRED HAND HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARESE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-885-0848
Mailing Address - Street 1:1515 HORNSBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1407
Mailing Address - Country:US
Mailing Address - Phone:314-716-3989
Mailing Address - Fax:
Practice Address - Street 1:1515 HORNSBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1407
Practice Address - Country:US
Practice Address - Phone:314-716-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health