Provider Demographics
NPI:1598112971
Name:A HEART FULL OF LOVE IN HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:A HEART FULL OF LOVE IN HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-643-9225
Mailing Address - Street 1:4149 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3824
Mailing Address - Country:US
Mailing Address - Phone:314-643-9225
Mailing Address - Fax:314-480-6179
Practice Address - Street 1:4149 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-3824
Practice Address - Country:US
Practice Address - Phone:314-643-9225
Practice Address - Fax:314-480-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care