MEDICARE: LIVE 2 GIVE IN HOME HEALTHCARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1306430673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE 2 GIVE IN HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	5232 S KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2923
Country	:	US
Telephone Number	:	314-223-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5232 S KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2923
Country	:	US
Telephone Number	:	314-223-6191
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JOHNNY L HOWARD JR.
Credential	:
Telephone Number	:	314-223-6191

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	08/13/2021

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