MEDICARE: CHEROKEE LOVE 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	374U00000X	Home Health Aide
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1821575788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEROKEE LOVE LLC

Provider Business Mailing Address
First Line	:	3416 CHEROKEE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2702
Country	:	US
Telephone Number	:	314-646-9302
Fax Number	:

Provider Business Practice Location Address
First Line	:	3416 CHEROKEE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2702
Country	:	US
Telephone Number	:	314-646-9302
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAMIKA HOLLINS
Credential	:
Telephone Number	:	314-646-9302

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	06/06/2019

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Directions to “CHEROKEE LOVE LLC ” Practice Location

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