MEDICARE: FILLING THE GAP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1447034723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FILLING THE GAP LLC

Provider Business Mailing Address
First Line	:	231 S BEMISTON AVE STE 800
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-1925
Country	:	US
Telephone Number	:	314-397-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 S BEMISTON AVE STE 800
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-1925
Country	:	US
Telephone Number	:	314-397-7625
Fax Number	:

Authorized Official
Title or Position	:	EXECECTIVE DIRECTOR
Name	:	RESHA R EVANS ALLEN
Credential	:
Telephone Number	:	314-397-7625

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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