Provider Demographics
NPI:1235637422
Name:NEW SEASON HOME HEALTH IN HOME LLC
Entity type:Organization
Organization Name:NEW SEASON HOME HEALTH IN HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:SHERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-699-5607
Mailing Address - Street 1:3486A HOLLENBERG DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2429
Mailing Address - Country:US
Mailing Address - Phone:314-287-3628
Mailing Address - Fax:314-778-3456
Practice Address - Street 1:11520 SAINT CHARLES ROCK RD STE 102A
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2732
Practice Address - Country:US
Practice Address - Phone:314-287-3628
Practice Address - Fax:314-778-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16-9919891Medicaid