Provider Demographics
NPI:1255851093
Name:KW IN-HOME HEALTH SERVICE LLC
Entity Type:Organization
Organization Name:KW IN-HOME HEALTH SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LLC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-932-6485
Mailing Address - Street 1:7914 COOL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-2023
Mailing Address - Country:US
Mailing Address - Phone:409-932-6485
Mailing Address - Fax:
Practice Address - Street 1:1515 N WARSON RD STE 113
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1108
Practice Address - Country:US
Practice Address - Phone:409-932-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care