Healthcare Provider Details

I. General information

NPI: 1093461618
Provider Name (Legal Business Name): DLW WELLNESS IHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N WARSON RD STE 217
SAINT LOUIS MO
63132-1115
US

IV. Provider business mailing address

1515 N WARSON RD STE 217
SAINT LOUIS MO
63132-1115
US

V. Phone/Fax

Practice location:
  • Phone: 314-458-8853
  • Fax:
Mailing address:
  • Phone: 314-458-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN LAKEISHA WRIGHT
Title or Position: OWNER
Credential: DIRECTOR
Phone: 314-458-8853