Provider Demographics
NPI:1124221114
Name:DEER VALLEY HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DEER VALLEY HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-355-3679
Mailing Address - Street 1:8600 AIRPORT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-1937
Mailing Address - Country:US
Mailing Address - Phone:314-355-3679
Mailing Address - Fax:314-521-5661
Practice Address - Street 1:8600 AIRPORT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-1937
Practice Address - Country:US
Practice Address - Phone:314-355-3679
Practice Address - Fax:314-521-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0609431251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO286222609Medicaid
MO266222603Medicaid
MO946229705Medicaid