Provider Demographics
NPI:1366991473
Name:AT EAZE HOME HEALTH LLC
Entity type:Organization
Organization Name:AT EAZE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-322-9083
Mailing Address - Street 1:1515 N WARSON RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1111
Mailing Address - Country:US
Mailing Address - Phone:314-736-1102
Mailing Address - Fax:
Practice Address - Street 1:11941 SAN ANDRES DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-3649
Practice Address - Country:US
Practice Address - Phone:314-322-9083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health