Provider Demographics
NPI:1265832182
Name:LATTIMORE'S HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:LATTIMORE'S HOME HEALTH CARE SERVICES, LLC
Other - Org Name:NEW LIFE HOME HEALTH CARE AGENCY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LATTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-546-8855
Mailing Address - Street 1:9191 W. FLORISSANT AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136
Mailing Address - Country:US
Mailing Address - Phone:314-783-9445
Mailing Address - Fax:314-993-6944
Practice Address - Street 1:9191 W. FLORISSANT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-783-9445
Practice Address - Fax:314-993-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X251E00000X
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid