Healthcare Provider Details

I. General information

NPI: 1235041443
Provider Name (Legal Business Name): FIVE STAR SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BOARDWALK GARDENS DR
O FALLON MO
63368-3915
US

IV. Provider business mailing address

161 BOARDWALK GARDENS DR
O FALLON MO
63368-3915
US

V. Phone/Fax

Practice location:
  • Phone: 314-680-9471
  • Fax:
Mailing address:
  • Phone: 314-680-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AGYEMAN MANU-DAPAAH
Title or Position: OWNER
Credential:
Phone: 314-680-9471