Provider Demographics
NPI:1710503073
Name:UNCONDITIONAL CARE SERVICES,
Entity Type:Organization
Organization Name:UNCONDITIONAL CARE SERVICES,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-287-8957
Mailing Address - Street 1:626 EASTGATE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4821
Mailing Address - Country:US
Mailing Address - Phone:314-287-8957
Mailing Address - Fax:
Practice Address - Street 1:626 EASTGATE AVE APT 3
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4821
Practice Address - Country:US
Practice Address - Phone:314-287-8957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health