Avi Marie Vitality Home Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

AVI MARIE VITALITY HOME CARE LLC

Practice address

7777 Bonhomme Ave Ste 1827
Saint Louis, MO 63105-1911

Phone

(314) 764-5020

Fax

(636) 237-8304

NPI assigned

Nov 5, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Melody Tareka Moore

Title

Owner

Phone

(770) 596-8919

Specialties & licenses 1

Addresses

Other names 1

• NA Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1417558412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7777 BONHOMME STE #1827",
            "address_2": "8321 MCLARAN AVE",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631361129",
            "telephone_number": "314-764-5020",
            "fax_number": "636-237-8304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 BONHOMME AVE STE 1827",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631051911",
            "telephone_number": "314-764-5020",
            "fax_number": "636-237-8304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVI MARIE VITALITY HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-05",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MELODY",
        "authorized_official_middle_name": "TAREKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-596-8919"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.