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General NPI Number Information
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NPI Number | 1992241202
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Entity Type | Organization
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Legal Business Name | BUNDLES OF LOVE IN HOME SERVICES
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 501 N TAYLOR AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1810
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Country | US
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Telephone | 314-696-8600
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Fax | 314-696-8899
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Provider Business Mailing Address
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Address Line | 501 N TAYLOR AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1810
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Country | US
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Telephone | 314-696-8600
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Fax | 314-696-8899
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TEQUILA DIONTA CLARK
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Credential |
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Telephone | 314-696-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | LC9819745
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | LC9819745
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License Number State | MO
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