Provider Demographics
NPI:1245970870
Name:AMARIE'S HEALTHCARE
Entity type:Organization
Organization Name:AMARIE'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-368-5638
Mailing Address - Street 1:1916 LUCAS AVE APT 226
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1746
Mailing Address - Country:US
Mailing Address - Phone:314-368-5638
Mailing Address - Fax:314-720-9273
Practice Address - Street 1:1916 LUCAS AVE APT 226
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1746
Practice Address - Country:US
Practice Address - Phone:314-368-5638
Practice Address - Fax:314-720-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3143687538Medicaid