Provider Demographics
NPI:1396359204
Name:GUARDIAN OF LOVE HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GUARDIAN OF LOVE HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERTONNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY-MILIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-896-6658
Mailing Address - Street 1:PO BOX 37092
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-1592
Mailing Address - Country:US
Mailing Address - Phone:636-896-6658
Mailing Address - Fax:
Practice Address - Street 1:2570 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3611
Practice Address - Country:US
Practice Address - Phone:314-666-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty