Healthcare Provider Details

I. General information

NPI: 1801036793
Provider Name (Legal Business Name): LIFETIME SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6748 FYLER AVE
SAINT LOUIS MO
63139-2239
US

IV. Provider business mailing address

6748 FYLER AVE
SAINT LOUIS MO
63139-2239
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-1813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CYNTHIA COMPTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-599-7020