Healthcare Provider Details

I. General information

NPI: 1346130952
Provider Name (Legal Business Name): LYFE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SPRING AVE STE C7
SAINT LOUIS MO
63108-3629
US

IV. Provider business mailing address

929 N SPRING AVE STE C7
SAINT LOUIS MO
63108-3629
US

V. Phone/Fax

Practice location:
  • Phone: 314-202-1097
  • Fax:
Mailing address:
  • Phone: 314-202-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. KALIB MARKE' BRANDON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-202-1097