Provider Demographics
NPI:1689925752
Name:NBA HEALTHCARE
Entity Type:Organization
Organization Name:NBA HEALTHCARE
Other - Org Name:BRIGHTSTAR OF EAST ST. CHARLES COUNTY MO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-866-0722
Mailing Address - Street 1:1811 SHERMAN DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3976
Mailing Address - Country:US
Mailing Address - Phone:636-866-0722
Mailing Address - Fax:636-866-0729
Practice Address - Street 1:1811 SHERMAN DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3976
Practice Address - Country:US
Practice Address - Phone:636-866-0722
Practice Address - Fax:636-866-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21643369251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health