Provider Demographics
NPI:1295720118
Name:DELMAR GARDENS HOME CARE, INC.
Entity type:Organization
Organization Name:DELMAR GARDENS HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-733-7330
Mailing Address - Street 1:14805 N OUTER 40 RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-6060
Mailing Address - Country:US
Mailing Address - Phone:636-733-7000
Mailing Address - Fax:636-733-7010
Practice Address - Street 1:14805 N OUTER 40 RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6060
Practice Address - Country:US
Practice Address - Phone:636-733-7330
Practice Address - Fax:636-733-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO493-19HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO586849705Medicaid
MO267431Medicare Oscar/Certification