=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346773769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITH, HOPE & LOVE HOMECARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2017
-----------------------------------------------------
Last Update Date | 04/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 GARY CT APT D
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-546-9485
-----------------------------------------------------
Fax | 314-260-1116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 GARY CT APT D
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-546-9485
-----------------------------------------------------
Fax | 314-260-1116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | FELISHA BASS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-546-9485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------