MEDICARE: LOVING ANGELS HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1326508052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING ANGELS HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	5411 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1805
Country	:	US
Telephone Number	:	314-499-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	5411 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1805
Country	:	US
Telephone Number	:	314-499-3405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRY BROOKS
Credential	:
Telephone Number	:	314-499-3405

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	03/20/2019

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