Provider Demographics
NPI:1871056473
Name:MARY J'S HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MARY J'S HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOCK
Authorized Official - Middle Name:O
Authorized Official - Last Name:WINBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-795-7860
Mailing Address - Street 1:3700 NATURAL BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-2205
Mailing Address - Country:US
Mailing Address - Phone:314-795-7860
Mailing Address - Fax:314-584-7004
Practice Address - Street 1:2760 REDMAN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4653
Practice Address - Country:US
Practice Address - Phone:314-795-7860
Practice Address - Fax:314-584-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health