Individual
CHARISE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5056A MARDEL AVE, SAINT LOUIS, MO 63109-1730
(314) 262-1476
Mailing address
5056A MARDEL AVE, SAINT LOUIS, MO 63109-1730
(314) 262-1476
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
LC001549753
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251E00000X
—
MO
Enumeration date
08/08/2017
Last updated
07/21/2022
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