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5669 Delmar Blvd. St. Louis MO 63112 | |
| (314) 531-1770 | |
| (314) 241-1185 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5669 Delmar Blvd., St. Louis, Missouri |
| Authorized Official Name and Position | Mark Sanford (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 3143677848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5701 Delmar Blvd. St. Louis MO 63112-2617 Ph: (314) 367-7848 | 5669 Delmar Blvd. St. Louis MO 63112 Ph: (314) 531-1770 |
| NPI Number | 1649049842 |
|---|---|
| Provider Enumeration Date | 12/28/2023 |
| Last Update Date | 12/03/2024 |
| Certification Date | 12/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649049842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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