Provider Demographics
NPI:1205297769
Name:COMFORT HOME CARE LLC
Entity type:Organization
Organization Name:COMFORT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDS DIRECTOR COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUJAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-220-7671
Mailing Address - Street 1:128 ENCHANTED PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5497
Mailing Address - Country:US
Mailing Address - Phone:636-220-7671
Mailing Address - Fax:877-487-6101
Practice Address - Street 1:128 ENCHANTED PKWY STE 205
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5497
Practice Address - Country:US
Practice Address - Phone:636-220-7671
Practice Address - Fax:877-487-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MOLC001483326251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1205297769Medicaid