Provider Demographics
NPI:1649265562
Name:DELMAR GARDENS PRIVATE SERVICES, LLC
Entity type:Organization
Organization Name:DELMAR GARDENS PRIVATE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MICHAEL
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 STE 320A
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-6021
Mailing Address - Country:US
Mailing Address - Phone:636-733-7100
Mailing Address - Fax:636-733-7101
Practice Address - Street 1:14805 N OUTER 40 RD STE 320A
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6021
Practice Address - Country:US
Practice Address - Phone:636-733-7100
Practice Address - Fax:636-733-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260563713Medicaid
MO280563701Medicaid