| Pure Living Recovery And Rehabilition Center | |
|
5601 State St East Saint Louis IL 62203-1346 | |
| (314) 701-0405 | |
| Not Available |
| Full Name | Pure Living Recovery And Rehabilition Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5601 State St, East Saint Louis, Illinois |
| Authorized Official Name and Position | Reginald Demarial Smith (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3147010405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Living Recovery And Rehabilition Center 5601 State St East Saint Louis IL 62203-1346 Ph: (314) 701-0405 | Pure Living Recovery And Rehabilition Center 5601 State St East Saint Louis IL 62203-1346 Ph: (314) 701-0405 |
| NPI Number | 1992556773 |
|---|---|
| Provider Enumeration Date | 03/29/2024 |
| Last Update Date | 03/29/2024 |
| Certification Date | 03/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992556773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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