Provider Demographics
NPI:1710425491
Name:BI-STATE HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:BI-STATE HOME HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-791-2228
Mailing Address - Street 1:10338 JILLANA KAYE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-2034
Mailing Address - Country:US
Mailing Address - Phone:281-712-2181
Mailing Address - Fax:844-331-5857
Practice Address - Street 1:1100 N SARAH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3132
Practice Address - Country:US
Practice Address - Phone:832-791-2228
Practice Address - Fax:877-889-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1609244292Medicaid