Provider Demographics
NPI:1659776680
Name:THE WAYFARING PLACE IN HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:THE WAYFARING PLACE IN HOME HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUNN-WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-218-8711
Mailing Address - Street 1:1480 WOODSTONE DR. UNIT 105
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-3429
Mailing Address - Country:US
Mailing Address - Phone:314-218-8711
Mailing Address - Fax:314-754-2649
Practice Address - Street 1:1480 WOODSTONE DR. UNIT 105
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-3429
Practice Address - Country:US
Practice Address - Phone:314-218-8711
Practice Address - Fax:314-754-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPN036776251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health