Healthcare Provider Details

I. General information

NPI: 1285904268
Provider Name (Legal Business Name): SUPPORT INNOVATIONS PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 DAUTEL LN
SAINT LOUIS MO
63146-5533
US

IV. Provider business mailing address

13422 CLAYTON RD SUITE 214
SAINT LOUIS MO
63131-1008
US

V. Phone/Fax

Practice location:
  • Phone: 314-983-9172
  • Fax: 314-994-0664
Mailing address:
  • Phone: 314-205-0588
  • Fax: 314-205-0586

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: TIMOTHY KLEINLEIN
Title or Position: PRESIDENT
Credential:
Phone: 314-205-0588