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Organization
SHANNON PRIVATE HOME CARE
Active
Organization
SHANNON PRIVATE HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS BUCKLEY (PRESIDENT)
(314) 591-1309
Entity
Organization
Contact information
Practice address
2816 LIBERTY LANDING CT, FLORISSANT, MO 63033-7617
(314) 591-1309
(314) 741-3716
Mailing address
2816 LIBERTY LANDING CT, FLORISSANT, MO 63033-7617
(314) 591-1309
(314) 741-3716
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
372500000X
Chore Provider
—
—
376J00000X
Homemaker
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
10/19/2009
Last updated
02/25/2010
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