Healthcare Provider Details

I. General information

NPI: 1134973829
Provider Name (Legal Business Name): LATITIANA'S HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MACKLIND AVE STE 225B
SAINT LOUIS MO
63110-1432
US

IV. Provider business mailing address

1230 MACKLIND AVE # 115
SAINT LOUIS MO
63110-1432
US

V. Phone/Fax

Practice location:
  • Phone: 314-591-8105
  • Fax: 205-891-1684
Mailing address:
  • Phone: 314-591-8105
  • Fax: 205-891-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: CARMELLA L LAWRENCE
Title or Position: CEO
Credential:
Phone: 314-591-8105