Provider Demographics
NPI:1013669944
Name:POLARIS HOME HEALTH CARE ST LOUIS LLC
Entity Type:Organization
Organization Name:POLARIS HOME HEALTH CARE ST LOUIS LLC
Other - Org Name:AEVITAS HOME HEALTH OF ST LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-727-1634
Mailing Address - Street 1:525 CHESTNUT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2223
Mailing Address - Country:US
Mailing Address - Phone:516-727-1634
Mailing Address - Fax:
Practice Address - Street 1:13995 CLAYTON RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWN AND COUNTRY
Practice Address - State:MO
Practice Address - Zip Code:63017-8400
Practice Address - Country:US
Practice Address - Phone:516-727-1634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health