Provider Demographics
NPI:1669634531
Name:ALL FAMILY MEDICAID SERVICES LLC
Entity Type:Organization
Organization Name:ALL FAMILY MEDICAID SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-333-4204
Mailing Address - Street 1:9903 GRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-4207
Mailing Address - Country:US
Mailing Address - Phone:314-333-4204
Mailing Address - Fax:314-333-4189
Practice Address - Street 1:9903 GRAVOIS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-4207
Practice Address - Country:US
Practice Address - Phone:314-333-4204
Practice Address - Fax:314-333-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health