Provider Demographics
NPI:1578168605
Name:CHANGE OF TIME HOME HEALTH LLC
Entity Type:Organization
Organization Name:CHANGE OF TIME HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-757-5661
Mailing Address - Street 1:2176A N WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2301
Mailing Address - Country:US
Mailing Address - Phone:314-757-5661
Mailing Address - Fax:
Practice Address - Street 1:2176A N WATERFORD DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2301
Practice Address - Country:US
Practice Address - Phone:314-757-5661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health