MEDICARE: ETERNALLY LOVED HC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1144634320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETERNALLY LOVED HC SERVICES LLC

Provider Business Mailing Address
First Line	:	1409 WASHINGTON AVE STE 206
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1936
Country	:	US
Telephone Number	:	314-229-7941
Fax Number	:	314-972-7529

Provider Business Practice Location Address
First Line	:	1409 WASHINGTON AVE STE 206
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1936
Country	:	US
Telephone Number	:	314-229-7941
Fax Number	:	314-972-7529

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GABRIELLE SATTERFIELD
Credential	:
Telephone Number	:	314-299-7941

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	06/17/2014

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