Healthcare Provider Details

I. General information

NPI: 1821575788
Provider Name (Legal Business Name): CHEROKEE LOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 CHEROKEE ST
SAINT LOUIS MO
63118-2702
US

IV. Provider business mailing address

3416 CHEROKEE ST
SAINT LOUIS MO
63118-2702
US

V. Phone/Fax

Practice location:
  • Phone: 314-646-9302
  • Fax:
Mailing address:
  • Phone: 314-646-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMIKA HOLLINS
Title or Position: PRESIDENT
Credential:
Phone: 314-646-9302