Provider Demographics
NPI:1962045336
Name:ALLEGIANCE HOME HEALTHCARE CDS
Entity Type:Organization
Organization Name:ALLEGIANCE HOME HEALTHCARE CDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-341-0915
Mailing Address - Street 1:PO BOX 775015
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-5015
Mailing Address - Country:US
Mailing Address - Phone:314-341-0915
Mailing Address - Fax:314-839-8506
Practice Address - Street 1:6439 PLYMOUTH AVE # W116
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1905
Practice Address - Country:US
Practice Address - Phone:314-341-0915
Practice Address - Fax:314-839-8506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGIANCE HOME HEALTH CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty