Healthcare Provider Details

I. General information

NPI: 1255979894
Provider Name (Legal Business Name): DLW WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10532 PAGE AVE
SAINT LOUIS MO
63132-1202
US

IV. Provider business mailing address

12670 VERWOOD DR
FLORISSANT MO
63033-5132
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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

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