Provider Demographics
NPI:1790372274
Name:PLATINUM HEALTHCARE LIVING SERVICES LLC
Entity Type:Organization
Organization Name:PLATINUM HEALTHCARE LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONTAY
Authorized Official - Middle Name:SHANELLE
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-395-8708
Mailing Address - Street 1:1735 S NEW FLORISSANT RD STE C
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8300
Mailing Address - Country:US
Mailing Address - Phone:314-395-8707
Mailing Address - Fax:
Practice Address - Street 1:1735 S NEW FLORISSANT RD STE C
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8300
Practice Address - Country:US
Practice Address - Phone:314-395-8707
Practice Address - Fax:314-561-7489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health