Provider Demographics
NPI:1760021844
Name:HARD KNOCKS LLC
Entity Type:Organization
Organization Name:HARD KNOCKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-330-0434
Mailing Address - Street 1:614 WALMART DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3315
Mailing Address - Country:US
Mailing Address - Phone:314-330-0434
Mailing Address - Fax:
Practice Address - Street 1:3381 1ST ST
Practice Address - Street 2:
Practice Address - City:DOE RUN
Practice Address - State:MO
Practice Address - Zip Code:63637-3155
Practice Address - Country:US
Practice Address - Phone:314-330-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care