Provider Demographics
NPI:1346236007
Name:SIGNATURE FOUNDATION HOME HEALTH
Entity Type:Organization
Organization Name:SIGNATURE FOUNDATION HOME HEALTH
Other - Org Name:SIGNATURE HEALTH CARE FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMURE
Authorized Official - Suffix:
Authorized Official - Credentials:RN MHA
Authorized Official - Phone:314-416-1990
Mailing Address - Street 1:4850 LEMAY FERRY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1576
Mailing Address - Country:US
Mailing Address - Phone:314-416-1990
Mailing Address - Fax:314-416-7626
Practice Address - Street 1:4850 LEMAY FERRY RD
Practice Address - Street 2:STE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1576
Practice Address - Country:US
Practice Address - Phone:314-416-1990
Practice Address - Fax:314-416-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO768251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26 7561Medicare ID - Type Unspecified