Provider Demographics
NPI:1902963713
Name:MED-STAFF HOME HEALTH LV, LLC
Entity Type:Organization
Organization Name:MED-STAFF HOME HEALTH LV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THARENOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-997-3399
Mailing Address - Street 1:11901 OLIVE BLVD
Mailing Address - Street 2:#217
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6736
Mailing Address - Country:US
Mailing Address - Phone:314-997-3399
Mailing Address - Fax:314-993-5848
Practice Address - Street 1:1525 W WARM SPRINGS RD
Practice Address - Street 2:#410
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-4315
Practice Address - Country:US
Practice Address - Phone:702-731-6800
Practice Address - Fax:702-731-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4455HHA-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health