Provider Demographics
NPI:1669807756
Name:IDENTITY HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:IDENTITY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-252-0580
Mailing Address - Street 1:1456 GOODFELLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3736
Mailing Address - Country:US
Mailing Address - Phone:314-252-0580
Mailing Address - Fax:
Practice Address - Street 1:1456 GOODFELLOW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3736
Practice Address - Country:US
Practice Address - Phone:314-252-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-07
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health