Provider Demographics
NPI:1851715882
Name:LOVING CARE HOME CARE SERVICE LLC
Entity Type:Organization
Organization Name:LOVING CARE HOME CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLIS
Authorized Official - Middle Name:DELIS
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-486-1467
Mailing Address - Street 1:11360 GARDENVIEW LN
Mailing Address - Street 2:#4
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1066
Mailing Address - Country:US
Mailing Address - Phone:314-486-1467
Mailing Address - Fax:
Practice Address - Street 1:11360 GARDENVIEW LN
Practice Address - Street 2:#4
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1066
Practice Address - Country:US
Practice Address - Phone:314-486-1467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid