Organization
SELF RELIANT HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIA GRAY (EXECUTIVE DIRECTOR)
(636) 386-9340
Entity
Organization
Contact information
Practice address
9432 LACKLAND RD, OVERLAND, MO 63114-3601
(314) 764-1647
Mailing address
9432 LACKLAND RD, OVERLAND, MO 63114-3601
(314) 764-1647
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
11/02/2021
Last updated
11/02/2021
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