Healthcare Provider Details

I. General information

NPI: 1831675248
Provider Name (Legal Business Name): BOUNTIFUL BLESSINGS NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 OLD DORSETT RD
MARYLAND HEIGHTS MO
63043-3406
US

IV. Provider business mailing address

206 OLD DORSETT RD
MARYLAND HEIGHTS MO
63043-3406
US

V. Phone/Fax

Practice location:
  • Phone: 314-643-7861
  • Fax:
Mailing address:
  • Phone: 314-643-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL LEWIS
Title or Position: OWNER
Credential:
Phone: 314-922-8132