Healthcare Provider Details

I. General information

NPI: 1275475279
Provider Name (Legal Business Name): GOD GIVEN HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4064 MAFFITT AVE
SAINT LOUIS MO
63113-3235
US

IV. Provider business mailing address

6229 GREER AVE
SAINT LOUIS MO
63121-5619
US

V. Phone/Fax

Practice location:
  • Phone: 314-933-0155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LANISHA MARTIN
Title or Position: OWNER
Credential:
Phone: 314-933-0155