Provider Demographics
NPI:1174505564
Name:ALLEN HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:ALLEN HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-471-5411
Mailing Address - Street 1:808 S KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5919
Mailing Address - Country:US
Mailing Address - Phone:573-472-2644
Mailing Address - Fax:573-472-3501
Practice Address - Street 1:808 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5919
Practice Address - Country:US
Practice Address - Phone:573-472-2644
Practice Address - Fax:573-472-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-19
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO737-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-7532Medicare ID - Type UnspecifiedHOME HEALTH