Provider Demographics
NPI:1669800264
Name:ASCENSION IN-HOME HEALTHCARE LINK LLC
Entity type:Organization
Organization Name:ASCENSION IN-HOME HEALTHCARE LINK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-477-1002
Mailing Address - Street 1:320 BROOKES DR
Mailing Address - Street 2:SUITE 238
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-731-7144
Mailing Address - Fax:314-731-8110
Practice Address - Street 1:320 BROOKES DR
Practice Address - Street 2:SUITE 238
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2736
Practice Address - Country:US
Practice Address - Phone:314-731-7144
Practice Address - Fax:314-731-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1204478251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health