Provider Demographics
NPI:1881135952
Name:CINDYSHOMEHEALTHCARELLC
Entity type:Organization
Organization Name:CINDYSHOMEHEALTHCARELLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:GLYNETTE
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-427-9996
Mailing Address - Street 1:9424 GUTHRIE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-3914
Mailing Address - Country:US
Mailing Address - Phone:314-427-9996
Mailing Address - Fax:314-427-9998
Practice Address - Street 1:9424 GUTHRIE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-3914
Practice Address - Country:US
Practice Address - Phone:314-427-9996
Practice Address - Fax:314-427-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639505597Medicaid
MO1821370479Medicaid