Provider Demographics
NPI:1275196313
Name:AMERIPRIDE HOME CARE OF MISSOURI, INC
Entity Type:Organization
Organization Name:AMERIPRIDE HOME CARE OF MISSOURI, INC
Other - Org Name:AMERIPRIDE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-889-4567
Mailing Address - Street 1:1918 E MEADOWMERE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0333
Mailing Address - Country:US
Mailing Address - Phone:417-889-4567
Mailing Address - Fax:417-889-3073
Practice Address - Street 1:1918 E MEADOWMERE ST STE 9
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0333
Practice Address - Country:US
Practice Address - Phone:417-889-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM268876604Medicaid
MOM288876600Medicaid