MEDICARE: LOVING CARE HOME CARE 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	:	1962864322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING CARE HOME CARE LLC

Provider Business Mailing Address
First Line	:	4200 UNION BLVD STE 152
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-1227
Country	:	US
Telephone Number	:	314-486-1467
Fax Number	:

Provider Business Practice Location Address
First Line	:	2224 NORMANDY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4732
Country	:	US
Telephone Number	:	314-486-1467
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLIS DELIS TAYLOR
Credential	:
Telephone Number	:	314-486-1467

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	03/24/2016

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