Mandisa Fayola Mccormick- Nelson | Saint Louis, MO • PECOS Search

Mandisa Fayola Mccormick- Nelson

Home Health

Agencies

1534 Beecher Dr, Saint Louis, MO 63136-2306

PECOS Enrollment

Based on the most recent information from CMS, provider Mandisa Fayola Mccormick- Nelson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1356945000
Provider Type
Individual
Full Name
Mccormick- Nelson, Mandisa Fayola
Credential
ASSISTIVE CARE PRO

Gender
Female
Sole Proprietor
Yes
Enumeration Date
11/24/2020
Last Updated
1/19/2021

Contact Information

Practice Location

1534 Beecher Dr, Saint Louis, MO 63136-2306

Unlisted Fax

Mailing Location

1534 Beecher Dr, Saint Louis, MO 63136-2306

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 251E00000X Primary	Description Home Health Agencies	License Unlisted Issuer Missouri
Code 3747A0650X	Description Technician Nursing Service Related Providers	License Unlisted Issuer