MEDICARE: MARY'S LOVE-N-CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		MO
2	253Z00000X	In Home Supportive Care Agency		MO

General Provider Information

NPI Number	:	1265832976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY'S LOVE-N-CARE LLC

Provider Business Mailing Address
First Line	:	6350 EL SERRANO DR
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63033-8120
Country	:	US
Telephone Number	:	314-942-7048
Fax Number	:

Provider Business Practice Location Address
First Line	:	6350 EL SERRANO DR
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63033-8120
Country	:	US
Telephone Number	:	314-942-7048
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. ANISSA LOWERY
Credential	:
Telephone Number	:	314-942-7048

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	07/21/2022

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