Provider Demographics
NPI:1386630036
Name:MED-STAFF HOME HEALTH, LLC
Entity Type:Organization
Organization Name:MED-STAFF HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-237-3920
Mailing Address - Street 1:301 SOVEREIGN CT STE 209
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4435
Mailing Address - Country:US
Mailing Address - Phone:314-993-4663
Mailing Address - Fax:314-993-5848
Practice Address - Street 1:301 SOVEREIGN CT STE 209
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4435
Practice Address - Country:US
Practice Address - Phone:314-993-4663
Practice Address - Fax:314-993-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO267582251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO586104606Medicaid