Provider Demographics
NPI:1962098251
Name:HARBOR HILLS HOME HEALTH LLC
Entity type:Organization
Organization Name:HARBOR HILLS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KADIJIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-456-9414
Mailing Address - Street 1:849 WESTGATE AVE
Mailing Address - Street 2:UNIT 208
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:314-456-9414
Mailing Address - Fax:
Practice Address - Street 1:849 WESTGATE AVE
Practice Address - Street 2:UNIT 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130
Practice Address - Country:US
Practice Address - Phone:314-456-9414
Practice Address - Fax:314-786-6416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT1019Medicaid