Provider Demographics
NPI:1568602993
Name:MEDICAL IN-HOME HEALTH CARE
Entity Type:Organization
Organization Name:MEDICAL IN-HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-653-6213
Mailing Address - Street 1:5201 BAY POINT DR.
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1734
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:314-653-0653
Practice Address - Street 1:5201 BAY POINT DR.
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1734
Practice Address - Country:US
Practice Address - Phone:314-653-6213
Practice Address - Fax:314-653-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care