Healthcare Provider Details

I. General information

NPI: 1598181471
Provider Name (Legal Business Name): YOUR TENDER LOVING CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N EUCLID AVE STE 551B
SAINT LOUIS MO
63108-1690
US

IV. Provider business mailing address

625 N EUCLID AVE STE 551B
SAINT LOUIS MO
63108-1690
US

V. Phone/Fax

Practice location:
  • Phone: 314-802-8080
  • Fax: 314-802-8082
Mailing address:
  • Phone: 314-802-8080
  • Fax: 314-802-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JACQUELYNE BODLEY
Title or Position: DIRECTOR
Credential:
Phone: 314-802-8080