Healthcare Provider Details

I. General information

NPI: 1588370407
Provider Name (Legal Business Name): PETRE CONSTRUCTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MOTHERHEAD RD
SAINT CHARLES MO
63304-7664
US

IV. Provider business mailing address

1016 MOTHERHEAD RD
SAINT CHARLES MO
63304-7664
US

V. Phone/Fax

Practice location:
  • Phone: 314-504-8022
  • Fax:
Mailing address:
  • Phone: 314-504-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MARK EDWARD PETRE
Title or Position: PRESIDENT
Credential:
Phone: 636-939-5919