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General NPI Number Information
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NPI Number | 1275057291
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Entity Type | Organization
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Legal Business Name | LOVE TO LIFE
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8229 N BROADWAY
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City | SAINT LOUIS
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State | MO
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Zip | 63147-2323
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Country | US
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Telephone | 314-643-5369
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Fax |
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Provider Business Mailing Address
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Address Line | 8229 N BROADWAY
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City | SAINT LOUIS
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State | MO
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Zip | 63147-2323
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Country | US
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Telephone | 314-643-5369
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/CEO
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Name | BEULAH B BRANDON
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Credential | PH.D
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Telephone | 314-643-5369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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