Healthcare Provider Details

I. General information

NPI: 1427409259
Provider Name (Legal Business Name): YOUR TENDER LOVING CARE II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CHURCH ST SUITE 132
FERGUSON MO
63135-2442
US

IV. Provider business mailing address

119 CHURCH ST SUITE 132
FERGUSON MO
63135-2442
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-9825
  • Fax: 314-942-9838
Mailing address:
  • Phone: 314-942-9825
  • Fax: 314-942-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JACQUELYNE BODLEY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 314-942-9825