Provider Demographics
NPI:1497195929
Name:DOUBLE D INVESTMENT GROUP, LLC
Entity Type:Organization
Organization Name:DOUBLE D INVESTMENT GROUP, LLC
Other - Org Name:CITY HOME CARE PHASE II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN HOWZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-241-1210
Mailing Address - Street 1:1409 WASHINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1936
Mailing Address - Country:US
Mailing Address - Phone:314-241-1210
Mailing Address - Fax:314-241-1248
Practice Address - Street 1:1409 WASHINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1936
Practice Address - Country:US
Practice Address - Phone:314-241-1210
Practice Address - Fax:314-241-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1124364609Medicaid