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General NPI Number Information
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NPI Number | 1962190215
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Entity Type | Organization
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Legal Business Name | PURE LOVE CDS SERVICES LLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 9319 MIDLAND BLVD STE C
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City | SAINT LOUIS
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State | MO
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Zip | 63114-5459
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Country | US
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Telephone | 636-306-3622
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Fax | 636-203-4435
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Provider Business Mailing Address
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Address Line | 9319 MIDLAND BLVD STE C
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City | SAINT LOUIS
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State | MO
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Zip | 63114-5459
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Country | US
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Telephone | 636-306-3622
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Fax | 636-203-4435
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Authorized Official
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Title or Position | EXC DIRECTOR
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Name | MICAI LEVENBERRY
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Credential |
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Telephone | 636-368-7266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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