Provider Demographics
NPI:1326232752
Name:SSM HOME CARE PRIVATE DUTY
Entity Type:Organization
Organization Name:SSM HOME CARE PRIVATE DUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-989-2528
Mailing Address - Street 1:1912 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2647
Mailing Address - Country:US
Mailing Address - Phone:660-562-7905
Mailing Address - Fax:660-562-7948
Practice Address - Street 1:1912 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2647
Practice Address - Country:US
Practice Address - Phone:660-562-7905
Practice Address - Fax:660-562-7948
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM HEALTH BUSINESSES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health