Provider Demographics
NPI:1588852586
Name:PERSONAL CARE HOME HEALTH SVCS., LLC
Entity Type:Organization
Organization Name:PERSONAL CARE HOME HEALTH SVCS., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-664-1100
Mailing Address - Street 1:4142 DR MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-2730
Mailing Address - Country:US
Mailing Address - Phone:314-664-1100
Mailing Address - Fax:314-664-1104
Practice Address - Street 1:4142 DR MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-2730
Practice Address - Country:US
Practice Address - Phone:314-664-1100
Practice Address - Fax:314-664-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268280401Medicaid
MO288280407Medicaid