Healthcare Provider Details

I. General information

NPI: 1659853208
Provider Name (Legal Business Name): LATTIMORES LOVES ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 W FLORISSANT AVE STE 210
SAINT LOUIS MO
63136-1424
US

IV. Provider business mailing address

9191 W FLORISSANT AVE STE 210
SAINT LOUIS MO
63136-1424
US

V. Phone/Fax

Practice location:
  • Phone: 314-395-2440
  • Fax: 314-395-2443
Mailing address:
  • Phone: 314-395-2440
  • Fax: 314-395-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEITA L LATTIMORE
Title or Position: MEMBER/OWNER
Credential:
Phone: 314-395-2440