# NIRVANA HEALTHCARE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1982212270
- **Authorized official:** TAYDREA MOORE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 874-7484

## Contact information

- **Practice address:** 4069 ASHBURY CROSSING DR, FLORISSANT, MO 63034-2884
- **Practice address phone:** (314) 874-7484
- **Practice address fax:** (314) 552-7140
- **Mailing address:** 4069 ASHBURY CROSSING DR, FLORISSANT, MO 63034-2884
- **Mailing address phone:** (314) 874-7484
- **Mailing address fax:** (314) 552-7140

## Taxonomy

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

## Other

- **Enumeration date:** 07/22/2020
- **Last updated:** 10/01/2020