NPIMap

Organization Active NPI

Provision Home Care Inc

  • In Home Supportive Care Agency
  • Olivette, MO
National Provider Identifier
1700259264
Registry record updated Nov 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
SSBG/GR0008084 Issued in MO
Legal business name
PROVISION HOME CARE INC
Practice address
9378 Olive Blvd
Suite #215
Olivette, MO 63132-3215
Phone
(314) 569-4121
NPI assigned
Nov 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2015

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

Authorized official

Name
Dr. Emmanuel B Opoku, PHARM.D.
Title
President/Manager
Phone
(314) 569-4121

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X SSBG/GR0008084 MO
Nursing Care Agency 251J00000X SSBG/GR0008084 MO
In Home Supportive Care Agency 253Z00000X SSBG/GR0008084 MO Primary

Addresses

Primary practice location

9378 Olive Blvd
Suite #215
Olivette, MO 63132-3215

Mailing address

9378 Olive Blvd
Suite #215
Olivette, MO 63132-3215
Phone (314) 569-4121

Other identifiers 1

IdentifierTypeStateIssuer
SSBG/GR0008084MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Provision Home Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446681600000",
    "number": "1700259264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9378 OLIVE BLVD",
            "address_2": "SUITE #215",
            "city": "OLIVETTE",
            "state": "MO",
            "postal_code": "631323215",
            "telephone_number": "314-569-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9378 OLIVE BLVD",
            "address_2": "SUITE #215",
            "city": "OLIVETTE",
            "state": "MO",
            "postal_code": "631323215",
            "telephone_number": "314-569-4121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-05",
        "last_updated": "2015-11-05",
        "status": "A",
        "authorized_official_last_name": "OPOKU",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT/MANAGER",
        "authorized_official_telephone_number": "314-569-4121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "MO",
            "license": "SSBG/GR0008084",
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MO",
            "license": "SSBG/GR0008084",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MO",
            "license": "SSBG/GR0008084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SSBG/GR0008084",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olivette, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.