Provider Demographics
NPI:1124548169
Name:EXPRESSIONS OF LOVE HOME HEALTHCARE SERVICE, LLC
Entity Type:Organization
Organization Name:EXPRESSIONS OF LOVE HOME HEALTHCARE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LA'TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDERNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-371-7418
Mailing Address - Street 1:1409 WASHINGTON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1409 WASHINGTON AVE STE 220
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1936
Practice Address - Country:US
Practice Address - Phone:314-241-2992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health