Provider Demographics
NPI:1487216909
Name:LATTIMORES HOME CARE, LLC
Entity Type:Organization
Organization Name:LATTIMORES HOME CARE, LLC
Other - Org Name:LATTIMORE'S HOME CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LATTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-395-2440
Mailing Address - Street 1:9191 W FLORISSANT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1424
Mailing Address - Country:US
Mailing Address - Phone:314-395-2440
Mailing Address - Fax:314-395-2443
Practice Address - Street 1:9191 W FLORISSANT AVE STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1424
Practice Address - Country:US
Practice Address - Phone:314-395-2440
Practice Address - Fax:314-395-2443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATTIMORE'S HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-04
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1018Medicaid