1265832182 NPI number — LATTIMORE'S HOME HEALTH CARE SERVICES, LLC

Table of content: (NPI 1265832182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265832182 NPI number — LATTIMORE'S HOME HEALTH CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LATTIMORE'S HOME HEALTH CARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265832182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9191 W. FLORISSANT AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ST. LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-783-9445
Provider Business Mailing Address Fax Number:
314-993-6944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9191 W. FLORISSANT AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-783-9445
Provider Business Practice Location Address Fax Number:
314-993-6944
Provider Enumeration Date:
08/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LATTIMORE
Authorized Official First Name:
KEITA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEMBER/MANAGER
Authorized Official Telephone Number:
314-546-8855

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  251E00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com