| Sana Lake Recovery Center, Llc | |
|
711 Old Ballas Road, Suite 203 Creve Coeur MO 63141-7013 | |
| (314) 392-3822 | |
| Not Available |
| Full Name | Sana Lake Recovery Center, Llc |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 711 Old Ballas Road, Suite 203, Creve Coeur, Missouri |
| Authorized Official Name and Position | Stacy Glenn (CHIEF CLINICAL OFFICER) |
| Authorized Official Contact | 3143923822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sana Lake Recovery Center, Llc 8350 State Route 30 Dittmer MO 63023 Ph: (314) 392-3822 | Sana Lake Recovery Center, Llc 711 Old Ballas Road, Suite 203 Creve Coeur MO 63141-7013 Ph: (314) 392-3822 |
| NPI Number | 1427637560 |
|---|---|
| Provider Enumeration Date | 04/06/2021 |
| Last Update Date | 04/06/2021 |
| Certification Date | 04/06/2021 |
| Medicare PECOS PAC ID | 0143752766 |
|---|---|
| Medicare Enrollment ID | O20241021000703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427637560 | NPI | - | NPPES |
| Provider Name | Rolando A Larice |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356324917 PECOS PAC ID: 3971581638 Enrollment ID: I20040709000303 |
| Provider Name | Catherine Kluge |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184072712 PECOS PAC ID: 7719419332 Enrollment ID: I20241021000556 |
| Provider Name | Theresa M Pace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013342187 PECOS PAC ID: 6103351465 Enrollment ID: I20241122002158 |
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