Provider Demographics
NPI:1760018436
Name:NANA AND JACK'S IN-HOME HEALTHCARE ,LLC
Entity type:Organization
Organization Name:NANA AND JACK'S IN-HOME HEALTHCARE ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-449-1427
Mailing Address - Street 1:1409 WASHINGTON AVE STE 419
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1917
Mailing Address - Country:US
Mailing Address - Phone:314-449-1427
Mailing Address - Fax:
Practice Address - Street 1:1409 WASHINGTON AVE STE 419
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1917
Practice Address - Country:US
Practice Address - Phone:314-449-1427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty