Provider Demographics
NPI:1417533803
Name:SAINT. MARY'S COMPLETE HOME CARE, LLC
Entity Type:Organization
Organization Name:SAINT. MARY'S COMPLETE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ENYONAM
Authorized Official - Last Name:ANYIMADU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:131-463-2683
Mailing Address - Street 1:11628 OLD BALLAS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7030
Mailing Address - Country:US
Mailing Address - Phone:314-632-6839
Mailing Address - Fax:
Practice Address - Street 1:11628 OLD BALLAS RD STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7030
Practice Address - Country:US
Practice Address - Phone:314-632-6839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care