Healthcare Provider Details

I. General information

NPI: 1588865588
Provider Name (Legal Business Name): LOVING CARE REST HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 CLARKE ST
DE SOTO MO
63020-2709
US

IV. Provider business mailing address

PO BOX 711
DE SOTO MO
63020-0711
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-7871
  • Fax:
Mailing address:
  • Phone: 636-586-7871
  • Fax: 636-586-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number033995
License Number StateMO

VIII. Authorized Official

Name: MS. DANA DANICE CHRISTIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 636-586-7871