Provider Demographics
NPI:1588217418
Name:DEAL DEVOTED HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:DEAL DEVOTED HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHABAUT
Authorized Official - Middle Name:BAHT
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-332-0758
Mailing Address - Street 1:2235 THUNDERBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1744
Mailing Address - Country:US
Mailing Address - Phone:314-332-0758
Mailing Address - Fax:
Practice Address - Street 1:2235 THUNDERBIRD AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1744
Practice Address - Country:US
Practice Address - Phone:314-332-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3081Medicaid