Provider Demographics
NPI:1588815153
Name:PARAQUAD IN-HOME SERVICES
Entity Type:Organization
Organization Name:PARAQUAD IN-HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-289-4200
Mailing Address - Street 1:5240 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1436
Mailing Address - Country:US
Mailing Address - Phone:314-289-4200
Mailing Address - Fax:314-289-4201
Practice Address - Street 1:5240 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1436
Practice Address - Country:US
Practice Address - Phone:314-289-4200
Practice Address - Fax:314-289-4201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAQUAD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-01
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266212901Medicaid