MEDICARE: GOD GIVEN HEART 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	:	1275475279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOD GIVEN HEART LLC

Provider Business Mailing Address
First Line	:	6229 GREER AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-5619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4064 MAFFITT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63113-3235
Country	:	US
Telephone Number	:	314-933-0155
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LANISHA MARTIN
Credential	:
Telephone Number	:	314-933-0155

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “GOD GIVEN HEART LLC ” Practice Location

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