Healthcare Provider Details

I. General information

NPI: 1760305189
Provider Name (Legal Business Name): SHINES WITH LOVE LLC CONSUMER DIRECT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 ST.LOUIS AVE
ST LOUIS MO
63115
US

IV. Provider business mailing address

6022 GARFIELD AVE
SAINT LOUIS MO
63134-2110
US

V. Phone/Fax

Practice location:
  • Phone: 314-629-7707
  • Fax:
Mailing address:
  • Phone: 314-629-7707
  • 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: DAWN PHIFER
Title or Position: OWNER/MEMBER
Credential:
Phone: 314-629-7707