Provider Demographics
NPI:1386911121
Name:CHARITY'S HOME HEALTH CARE AVENCY, INC
Entity type:Organization
Organization Name:CHARITY'S HOME HEALTH CARE AVENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORELINE
Authorized Official - Middle Name:MILDRED
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-438-1800
Mailing Address - Street 1:12405 OLD HALLS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033
Mailing Address - Country:US
Mailing Address - Phone:314-438-1800
Mailing Address - Fax:314-438-9943
Practice Address - Street 1:12405 OLD HALLS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-438-1800
Practice Address - Fax:314-438-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00549535163W00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty