Healthcare Provider Details

I. General information

NPI: 1942933296
Provider Name (Legal Business Name): DIABETES EDUCATION AUGMENTING LIFESTYLES-CENTER AND CLINIC, LLC (DEAL-
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 MAGNOLIA AVE
SAINT LOUIS MO
63118-1272
US

IV. Provider business mailing address

3671 LAFAYETTE AVE
SAINT LOUIS MO
63110-2613
US

V. Phone/Fax

Practice location:
  • Phone: 314-441-6536
  • Fax:
Mailing address:
  • Phone: 314-346-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SONIA L DEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 314-346-2084