Healthcare Provider Details

I. General information

NPI: 1265832976
Provider Name (Legal Business Name): MARY'S LOVE-N-CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 EL SERRANO DR
ST. LOUIS MO
63033-8120
US

IV. Provider business mailing address

6350 EL SERRANO DR
ST. LOUIS MO
63033-8120
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-7048
  • Fax:
Mailing address:
  • Phone: 314-942-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. ANISSA LOWERY
Title or Position: DIRECTOR
Credential:
Phone: 314-942-7048