Healthcare Provider Details

I. General information

NPI: 1730781618
Provider Name (Legal Business Name): JCGILLESPIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 11/15/2020
Certification Date: 11/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 RANDOLPH AVE
SAINT LOUIS MO
63135-2655
US

IV. Provider business mailing address

327 RANDOLPH AVE
SAINT LOUIS MO
63135-2655
US

V. Phone/Fax

Practice location:
  • Phone: 314-243-5725
  • Fax:
Mailing address:
  • Phone: 314-243-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN GILLESPIE
Title or Position: CEO
Credential:
Phone: 314-283-9490