Healthcare Provider Details

I. General information

NPI: 1598343089
Provider Name (Legal Business Name): A LOVING HEART IN HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 GRAVOIS AVE
SAINT LOUIS MO
63118-1543
US

IV. Provider business mailing address

232 MIDWAY AVE
SAINT LOUIS MO
63122-6019
US

V. Phone/Fax

Practice location:
  • Phone: 314-616-4601
  • Fax:
Mailing address:
  • Phone: 314-443-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL IVORY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-443-5539