Provider Demographics
NPI:1467629659
Name:BJC HOME CARE SERVICES
Entity Type:Organization
Organization Name:BJC HOME CARE SERVICES
Other - Org Name:BJC IN-HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WESTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:314-953-1621
Mailing Address - Street 1:1935 BELT WAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5825
Mailing Address - Country:US
Mailing Address - Phone:314-953-1699
Mailing Address - Fax:314-273-0704
Practice Address - Street 1:757 WEBER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3318
Practice Address - Country:US
Practice Address - Phone:573-760-8552
Practice Address - Fax:573-760-8590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BJC HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-15
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00010828251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO288690100Medicaid