Provider Demographics
NPI:1992241202
Name:BUNDLES OF LOVE IN HOME SERVICES
Entity type:Organization
Organization Name:BUNDLES OF LOVE IN HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEQUILA
Authorized Official - Middle Name:DIONTA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-696-8600
Mailing Address - Street 1:501 N TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1810
Mailing Address - Country:US
Mailing Address - Phone:314-696-8600
Mailing Address - Fax:314-696-8899
Practice Address - Street 1:501 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1810
Practice Address - Country:US
Practice Address - Phone:314-696-8600
Practice Address - Fax:314-696-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC9819745251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health