Provider Demographics
NPI:1891337911
Name:PSG HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PSG HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FOLAHAN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:OLISHILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-838-9500
Mailing Address - Street 1:4009 7 HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6737
Mailing Address - Country:US
Mailing Address - Phone:314-838-9500
Mailing Address - Fax:314-828-8137
Practice Address - Street 1:4009 7 HILLS DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6737
Practice Address - Country:US
Practice Address - Phone:314-838-9500
Practice Address - Fax:314-828-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25751654Medicaid