Healthcare Provider Details

I. General information

NPI: 1144490616
Provider Name (Legal Business Name): LASTING IMPRESSIONS HOME REMODEL CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 N WATERFORD DR
FLORISSANT MO
63033-2301
US

IV. Provider business mailing address

2168 N WATERFORD DR
FLORISSANT MO
63033-2301
US

V. Phone/Fax

Practice location:
  • Phone: 314-837-7722
  • Fax: 314-837-0655
Mailing address:
  • Phone: 314-837-7722
  • Fax: 314-837-0655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA L. BILYEU
Title or Position: PRESIDENT
Credential:
Phone: 314-837-7722