Provider Demographics
NPI:1588028922
Name:GUIDEDBY GOD IN HOME HEALTH LLC
Entity Type:Organization
Organization Name:GUIDEDBY GOD IN HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:HERRON
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-764-2935
Mailing Address - Street 1:5918 EVERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:MO
Mailing Address - Zip Code:63134-2302
Mailing Address - Country:US
Mailing Address - Phone:314-764-2935
Mailing Address - Fax:314-764-2017
Practice Address - Street 1:5918 EVERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:MO
Practice Address - Zip Code:63134-2302
Practice Address - Country:US
Practice Address - Phone:314-764-2935
Practice Address - Fax:314-764-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0015469253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0015469Medicaid