Organization
PROVISION HOME CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH MILLARD ROBERTS (BILLER)
(314) 569-4121
Entity
Organization
Contact information
Practice address
9378 OLIVE BLVD, SUITE 215, SAINT LOUIS, MO 63132-3215
(314) 569-4121
(314) 569-4118
Mailing address
9378 OLIVE BLVD, SUITE 215, SAINT LOUIS, MO 63132-3215
(314) 569-4121
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
CC0635954
MO
Other
Enumeration date
03/12/2007
Last updated
08/22/2020
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