Provider Demographics
NPI:1790220796
Name:DTA HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DTA HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELONA
Authorized Official - Middle Name:DANAIL
Authorized Official - Last Name:BEVLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-680-0281
Mailing Address - Street 1:1822 DUNNIDEER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-3004
Mailing Address - Country:US
Mailing Address - Phone:314-680-0281
Mailing Address - Fax:
Practice Address - Street 1:1822 DUNNIDEER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-3004
Practice Address - Country:US
Practice Address - Phone:314-680-0281
Practice Address - Fax:314-388-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health