Provider Demographics
NPI:1447286554
Name:TEAM SELECT HOME CARE OF MISSOURI, INC.
Entity type:Organization
Organization Name:TEAM SELECT HOME CARE OF MISSOURI, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-618-5760
Mailing Address - Street 1:2999 N 44TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7247
Mailing Address - Country:US
Mailing Address - Phone:602-382-8500
Mailing Address - Fax:602-253-5656
Practice Address - Street 1:12125 WOODCREST EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5015
Practice Address - Country:US
Practice Address - Phone:314-669-8997
Practice Address - Fax:314-669-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO893-HH251E00000X, 251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267426Medicare Oscar/Certification
583102504OtherSKILLED MEDICAID
MO267426Medicare Oscar/Certification
283102507OtherHM RESPITE 19
854883808OtherDEPT OF MENTAL HEALTH
MOMW023200Medicaid
MO946964608Medicaid
MO263102501Medicaid