Organization
ICONIC HEALTH AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAMADIRE PATTERSON (OWNER)
(314) 322-2414
Entity
Organization
Contact information
Practice address
540 HUMES LN, FLORISSANT, MO 63031-3023
(314) 322-2414
Mailing address
1019 SKINKER PKWY APT 114, SAINT LOUIS, MO 63112-0017
(314) 322-2414
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
08/29/2024
Last updated
09/18/2024
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