Provider Demographics
NPI:1891705547
Name:BJC HOME CARE SERVICES
Entity Type:Organization
Organization Name:BJC HOME CARE SERVICES
Other - Org Name:BJC HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-206-3712
Mailing Address - Street 1:1935 BELT WAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5825
Mailing Address - Country:US
Mailing Address - Phone:314-953-1615
Mailing Address - Fax:314-273-0704
Practice Address - Street 1:1935 BELT WAY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5825
Practice Address - Country:US
Practice Address - Phone:314-953-1615
Practice Address - Fax:314-273-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00010918251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO820541506Medicaid
IL=========006Medicaid
MO820541506Medicaid