Provider Demographics
NPI:1609381045
Name:FRIENDSHIP VILLAGE AT HOME, LLC
Entity Type:Organization
Organization Name:FRIENDSHIP VILLAGE AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-270-7150
Mailing Address - Street 1:12563 VILLAGE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1758
Mailing Address - Country:US
Mailing Address - Phone:314-270-7333
Mailing Address - Fax:
Practice Address - Street 1:12563 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1758
Practice Address - Country:US
Practice Address - Phone:314-270-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health