Healthcare Provider Details

I. General information

NPI: 1609601210
Provider Name (Legal Business Name): LOVING GRACE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CLEWER PARK CT
LAKE SAINT LOUIS MO
63367-2262
US

IV. Provider business mailing address

305 CLEWER PARK CT
LAKE SAINT LOUIS MO
63367-2262
US

V. Phone/Fax

Practice location:
  • Phone: 636-698-2347
  • Fax:
Mailing address:
  • Phone: 636-698-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ESSENCE GREEN
Title or Position: OWNER/FOUNDER
Credential:
Phone: 636-698-2347