Healthcare Provider Details

I. General information

NPI: 1619720398
Provider Name (Legal Business Name): LATITIANA'S HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MACKLIND AVE. #115
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

1230 MACKLIND AVE. #115
SAINT LOUIS MO
63110
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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MS. CARMELLA L. LAWRENCE
Title or Position: OWNER
Credential:
Phone: 314-591-8105