| Grant Ventures Llc | |
|
5 Sage Meadows Ct O Fallon MO 63366-4189 | |
| (314) 474-0015 | |
| Not Available |
| Full Name | Grant Ventures Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5 Sage Meadows Ct, O Fallon, Missouri |
| Authorized Official Name and Position | David Dupriest Grant (OWNER) |
| Authorized Official Contact | 3144740015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grant Ventures Llc 5 Sage Meadows Ct O Fallon MO 63366-4189 Ph: (314) 474-0015 | Grant Ventures Llc 5 Sage Meadows Ct O Fallon MO 63366-4189 Ph: (314) 474-0015 |
| NPI Number | 1518671924 |
|---|---|
| Provider Enumeration Date | 01/10/2023 |
| Last Update Date | 01/10/2023 |
| Certification Date | 01/10/2023 |
| Medicare PECOS PAC ID | 7012381783 |
|---|---|
| Medicare Enrollment ID | O20230320002006 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518671924 | NPI | - | NPPES |
| 490112443 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | David Dupriest Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639622152 PECOS PAC ID: 8628453214 Enrollment ID: I20220919000537 |
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