| NPI | 1689282162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONI JANUARY Cmo 314-324-4631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 177F00000X Lodging |
| 207V00000X Obstetrics & Gynecology | |
| 253Z00000X In Home Supportive Care | |
| 261Q00000X Clinic/Center | |
| 261QF0050X Clinic/Center Family Planning, Non-Surgical | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2023-02-08 |