Healthcare Provider Details

I. General information

NPI: 1033873625
Provider Name (Legal Business Name): T&L PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S FLORISSANT RD STE 102
SAINT LOUIS MO
63135-2894
US

IV. Provider business mailing address

1490 PADDOCK DR
FLORISSANT MO
63033-2263
US

V. Phone/Fax

Practice location:
  • Phone: 314-478-7982
  • Fax:
Mailing address:
  • Phone:
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LA'SHAY DOUGLAS
Title or Position: OWNER
Credential:
Phone: 314-478-7982