Provider Demographics
NPI:1285178699
Name:D&K HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:D&K HOME HEALTHCARE, LLC
Other - Org Name:D&K HOME HEALTHCARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-643-1861
Mailing Address - Street 1:1249 BRENTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2411
Mailing Address - Country:US
Mailing Address - Phone:314-643-1861
Mailing Address - Fax:314-801-7730
Practice Address - Street 1:1249 BRENTHAVEN LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2411
Practice Address - Country:US
Practice Address - Phone:314-643-1861
Practice Address - Fax:314-801-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285178699Medicaid