Provider Demographics
NPI:1790967701
Name:LDI IV CARE LLC
Entity Type:Organization
Organization Name:LDI IV CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:314-652-2121
Mailing Address - Street 1:680 CRAIG ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7120
Mailing Address - Country:US
Mailing Address - Phone:314-652-2121
Mailing Address - Fax:314-652-2126
Practice Address - Street 1:65 SOUTH 65TH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2946
Practice Address - Country:US
Practice Address - Phone:618-398-2720
Practice Address - Fax:618-398-3458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEEHAR DISTRIBUTORS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health