Healthcare Provider Details

I. General information

NPI: 1801163381
Provider Name (Legal Business Name): STEP LIFE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 ORCHARD AVE
HANNIBAL MO
63401-6006
US

IV. Provider business mailing address

2012 ORCHARD AVE
HANNIBAL MO
63401-6006
US

V. Phone/Fax

Practice location:
  • Phone: 573-406-0500
  • Fax: 573-406-0502
Mailing address:
  • Phone: 573-406-0500
  • Fax: 573-406-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MISS SKIPPY MARGARET COFFMAN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 573-406-0500