Provider Demographics
NPI: | 1851803704 |
---|---|
Name: | HOWARD HOME HEALTH H3 LLC |
Entity Type: | Organization |
Organization Name: | HOWARD HOME HEALTH H3 LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ONWER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ABID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SECIC |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 314-452-3039 |
Mailing Address - Street 1: | 4604 VARRELMANN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT LOUIS |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63116-2418 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-452-3039 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4604 VARRELMANN AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAINT LOUIS |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63116-2418 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-452-3039 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-11-01 |
Last Update Date: | 2018-06-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | LC1376637 | 251E00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | ========= | Medicaid |