# SOURCE ONE HOME HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457117632
- **Authorized official:** SHAWNYAE BAKER (CEO)
- **Authorized official phone:** (314) 445-4392

## Contact information

- **Practice address:** 5145V WALLINGFORD DR, SAINT LOUIS, MO 63121-1014
- **Practice address phone:** (314) 445-4392
- **Mailing address:** 5145V WALLINGFORD DR, SAINT LOUIS, MO 63121-1014
- **Mailing address phone:** (314) 445-4392

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 02/26/2024
- **Last updated:** 02/26/2024