Provider Demographics
NPI:1366964363
Name:TRIPPLE B LLC
Entity type:Organization
Organization Name:TRIPPLE B LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMEIA
Authorized Official - Middle Name:EMERALD
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-473-2422
Mailing Address - Street 1:11441 BRISTOL ROCK RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7508
Mailing Address - Country:US
Mailing Address - Phone:314-473-2422
Mailing Address - Fax:
Practice Address - Street 1:11441 BRISTOL ROCK RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7508
Practice Address - Country:US
Practice Address - Phone:314-473-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid