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Organization
PROVISION HOME CARE INC
Active
Organization
PROVISION HOME CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMANUEL B OPOKU PHARM.D. (PRESIDENT/MANAGER)
(314) 569-4121
Entity
Organization
Contact information
Practice address
9378 OLIVE BLVD, SUITE #215, OLIVETTE, MO 63132-3215
(314) 569-4121
Mailing address
9378 OLIVE BLVD, SUITE #215, OLIVETTE, MO 63132-3215
(314) 569-4121
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
SSBG/GR0008084
MO
251J00000X
Nursing Care Agency
SSBG/GR0008084
MO
253Z00000X
In Home Supportive Care Agency
Primary
SSBG/GR0008084
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SSBG/GR0008084
—
MO
Enumeration date
11/05/2015
Last updated
11/05/2015
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