MEDICARE: TI-LOVING 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	310400000X	Assisted Living Facility	033007	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780890350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TI-LOVING CARE, LLC

Provider Business Mailing Address
First Line	:	3715 JAMIESON AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63109-1109
Country	:	US
Telephone Number	:	314-781-0222
Fax Number	:	314-645-7559

Provider Business Practice Location Address
First Line	:	3715 JAMIESON AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63109-1109
Country	:	US
Telephone Number	:	314-781-0222
Fax Number	:	314-645-7559

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WOLFGANG D VOLZ
Credential	:
Telephone Number	:	314-781-0222

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	03/01/2011

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