Provider Demographics
NPI:1164040549
Name:TYRONIA PORCHIA
Entity Type:Organization
Organization Name:TYRONIA PORCHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TYRONIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:PORCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-455-9312
Mailing Address - Street 1:8911 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4018
Mailing Address - Country:US
Mailing Address - Phone:314-455-9312
Mailing Address - Fax:
Practice Address - Street 1:8911 RAMONA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4018
Practice Address - Country:US
Practice Address - Phone:314-455-9312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLC9927162OtherBUSINESSE LICENSE