=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083054175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL LOVING CARE CONSUMER DIRECTED SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2013
-----------------------------------------------------
Last Update Date | 07/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3006 N LINDBERGH BLVD STE 709
-----------------------------------------------------
City | SAINT ANN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63074-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-739-4673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3006 N LINDBERGH BLVD STE 709
-----------------------------------------------------
City | SAINT ANN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63074-3242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-739-4673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARCHELLI GENEVIEVE JEMERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-739-4673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------