Organization
PROVISION HOME CARE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMMANUEL BOATENG OPOKU PHARM.D. (PRESIDENT)
(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
(314) 569-4118
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
CC0635954
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266200302
—
MO
Enumeration date
01/24/2006
Last updated
06/16/2014
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