# MOMBA HOME CARE MISSOURI, LLC

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

## Provider details

- **NPI number:** 1578300687
- **Authorized official:** ELAZAR HUISMAN (NPI MANAGER)
- **Authorized official phone:** (404) 418-7484

## Contact information

- **Practice address:** 100 CHESTERFIELD BUSINESS PKWY FL 2, CHESTERFIELD, MO 63005-1271
- **Practice address phone:** (314) 237-3633
- **Mailing address:** 400 PERIMETER CENTER TER NE STE 300, ATLANTA, GA 30346-1201
- **Mailing address phone:** (314) 237-3633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/15/2024
- **Last updated:** 06/18/2026