Organization
QUEEN HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHMOOD ABOSARA (DIRECTOR)
(314) 303-0433
Entity
Organization
Contact information
Practice address
4333 MANCHESTER AVE, SAINT LOUIS, MO 63110-2137
(314) 303-0433
Mailing address
4333 MANCHESTER AVE, SAINT LOUIS, MO 63110-2137
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23380446
BUSINESS TAX REGISTRATION - MO DEPARTMENT OF REVENUE
MO
Enumeration date
06/14/2017
Last updated
06/14/2017
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