Provider Demographics
NPI:1194500298
Name:AMIYA HAYDEN
Entity type:Organization
Organization Name:AMIYA HAYDEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-346-3308
Mailing Address - Street 1:111 CHURCH ST STE 209D
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2458
Mailing Address - Country:US
Mailing Address - Phone:636-346-3308
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST STE 209D
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2458
Practice Address - Country:US
Practice Address - Phone:636-346-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care