Provider Demographics
NPI:1780601450
Name:HEALTHLINE HOMECARE AGENCY LLC
Entity type:Organization
Organization Name:HEALTHLINE HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENDEROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-386-8228
Mailing Address - Street 1:930 KEHRS MILL RD
Mailing Address - Street 2:SUITE 325-10
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2462
Mailing Address - Country:US
Mailing Address - Phone:636-386-8228
Mailing Address - Fax:636-386-8245
Practice Address - Street 1:930 KEHRS MILL RD
Practice Address - Street 2:SUITE 325-10
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2462
Practice Address - Country:US
Practice Address - Phone:636-386-8228
Practice Address - Fax:636-386-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO773251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267598Medicare ID - Type Unspecified