Provider Demographics
NPI:1689962755
Name:YOUR COMFORT CARE HOME SERVICE
Entity Type:Organization
Organization Name:YOUR COMFORT CARE HOME SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:CAVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:314-973-1577
Mailing Address - Street 1:11220 W FLORISSANT AVE # 214
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6741
Mailing Address - Country:US
Mailing Address - Phone:314-973-1577
Mailing Address - Fax:314-450-4760
Practice Address - Street 1:3840 PARKER RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3239
Practice Address - Country:US
Practice Address - Phone:314-973-1577
Practice Address - Fax:314-450-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health