Healthcare Provider Details

I. General information

NPI: 1114448180
Provider Name (Legal Business Name): A DAUGHTERS LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 WASHINGTON BLVD
SAINT LOUIS MO
63108-3507
US

IV. Provider business mailing address

9757 LORNA LN
SAINT LOUIS MO
63136-1906
US

V. Phone/Fax

Practice location:
  • Phone: 314-229-8416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIAUNA DANIEL
Title or Position: DIRECTOR
Credential:
Phone: 314-229-8416