| NPI | 1871069062 |
|---|---|
| Doing Business As | LIFT FOR LIFE ACADEMY |
| Entity Type | Organization |
| Authorized Contact | CORINTHIA DARCEL JAMISON Credentialing Coordinator 314-814-8531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2018-10-16 |