Provider Demographics
NPI:1225192883
Name:BJC HOME CARE SERVICES
Entity Type:Organization
Organization Name:BJC HOME CARE SERVICES
Other - Org Name:BJC HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-206-3712
Mailing Address - Street 1:1935 BELT WAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5825
Mailing Address - Country:US
Mailing Address - Phone:314-953-2000
Mailing Address - Fax:314-953-2140
Practice Address - Street 1:301 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1751
Practice Address - Country:US
Practice Address - Phone:573-747-1075
Practice Address - Fax:573-747-1069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BJC HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO626170708Medicaid
MO0416200005Medicare NSC
IL=========002Medicaid