Healthcare Provider Details

I. General information

NPI: 1932445830
Provider Name (Legal Business Name): ABIDING FAITH HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 HALLS FERRY RD
SAINT LOUIS MO
63147-1701
US

IV. Provider business mailing address

9010 HALLS FERRY RD
SAINT LOUIS MO
63147-1701
US

V. Phone/Fax

Practice location:
  • Phone: 314-954-2437
  • Fax: 314-388-0804
Mailing address:
  • Phone: 314-954-2437
  • Fax: 314-388-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number163WC0400X
License Number StateMO

VIII. Authorized Official

Name: MARY PATRICIA MCCARTHY
Title or Position: R.N. ADMINISTRATOR
Credential:
Phone: 314-954-2437