Provider Demographics
NPI:1376546747
Name:ST. LOUIS HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ST. LOUIS HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-352-7889
Mailing Address - Street 1:1000 CAMERA AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1017
Mailing Address - Country:US
Mailing Address - Phone:314-352-7889
Mailing Address - Fax:314-352-7411
Practice Address - Street 1:1000 CAMERA AVE
Practice Address - Street 2:STE B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1017
Practice Address - Country:US
Practice Address - Phone:314-352-7889
Practice Address - Fax:314-352-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO577-8251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5109690OtherAETNA
MO6000150OtherUNITED HEALTH CARE
MO323747OtherHEALTHLINK
MO586092603Medicaid
MO000000010627OtherESSENCE
MO115184OtherBC/BS OF MISSOURI
MO141012300OtherUS DEPT OF LABOR
MO25008OtherGROUP HEALTH PLAN
MO=========OtherTAX ID