| Organization Name: | PROFESSIONAL IN-HOME CARE PROVIDER, LLC. |
| NPI Number: | 1568798213 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTOINETTE JONES (OWNER) |
| Mailing Address: | 11740 Carolview Dr Florissant |
| State: | MO US |
| Postal Code: | 630336802 |
| Phone Number: | 3148032798 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2009 |
| NPI Last Update Date: | 10/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |