Provider Demographics
NPI:1396302600
Name:5TH DIMENSION HOME CARE LLC
Entity type:Organization
Organization Name:5TH DIMENSION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-482-9254
Mailing Address - Street 1:15565 OLD JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15565 OLD JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1947
Practice Address - Country:US
Practice Address - Phone:314-482-9254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care