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Organization
WALLACE FAMILY IN HOME HEALTH LLC
Active
Organization
WALLACE FAMILY IN HOME HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY JACKSON (CEO)
(314) 713-1105
Entity
Organization
Contact information
Practice address
3937 PARK AVE, PARK WAREHOUSE, SAINT LOUIS, MO 63110-2317
(314) 713-1105
(314) 754-9969
Mailing address
6530 JULIAN AVE, SAINT LOUIS, MO 63133-1410
(314) 713-1105
(314) 754-9969
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
12/16/2014
Last updated
12/16/2014
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