Homestead Health Care IHS LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

HOMESTEAD HEALTH CARE IHS LLC

Practice address

12405 Old Halls Ferry Rd Ste 100
Black Jack, MO 63033-4261

Phone

(314) 757-9535

NPI assigned

Nov 3, 2020

Last updated

Jun 9, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Monique Montgomery

Title

Excutive Director

Phone

(314) 395-3006

Specialties & licenses 2

Addresses

Other names 1

• Homestead Health Care IHS LLC Former legal business name

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

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1942801345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12405 OLD HALLS FERRY RD STE 100",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630334261",
            "telephone_number": "314-395-3006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12405 OLD HALLS FERRY RD STE 100",
            "city": "BLACK JACK",
            "state": "MO",
            "postal_code": "630334261",
            "telephone_number": "314-757-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMESTEAD HEALTH CARE IHS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-03",
        "last_updated": "2023-06-09",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_title_or_position": "EXCUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-395-3006"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Homestead Health Care IHS LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Homestead Health Care IHS LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• In Home Supportive Care Agency in Black Jack, MO
• Providers in Black Jack, MO by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; 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.