Wallace Family in Home Health LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

WALLACE FAMILY IN HOME HEALTH LLC

Practice address

3937 Park Ave
Park Warehouse
Saint Louis, MO 63110-2317

Phone

(314) 713-1105

Fax

(314) 754-9969

NPI assigned

Dec 16, 2014

Organization subpart

No

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

Authorized official

Name

Brittany Jackson

Title

Ceo

Phone

(314) 713-1105

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1841698388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6530 JULIAN AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631331410",
            "telephone_number": "314-713-1105",
            "fax_number": "314-754-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3937 PARK AVE",
            "address_2": "PARK WAREHOUSE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102317",
            "telephone_number": "314-713-1105",
            "fax_number": "314-754-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE FAMILY IN HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "314-713-1105"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Leigh Wall, WHNP
• Leonard Lewis Wall, MD
• Megan Wall, DPT
• Tyler James Wall, MD
• Wallace Family Adult Daycare
• Wallace P Berkowitz MD LTD
• Andrew Blake Wallace, M.D.
• Angela Wallace, LPC
• Ashleigh Wallace, PHARMD
• Cassandra Marie Wallace, PNP

• In Home Supportive Care Agency in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• In Home Supportive Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; 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.