Healthcare Provider Details

I. General information

NPI: 1164801445
Provider Name (Legal Business Name): TRP COMMUNITY RESOURCE DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9374 OLIVE BLVD SUITE 101
SAINT LOUIS MO
63132-3253
US

IV. Provider business mailing address

9374 OLIVE BLVD SUITE 101
SAINT LOUIS MO
63132-3253
US

V. Phone/Fax

Practice location:
  • Phone: 314-400-1051
  • Fax:
Mailing address:
  • Phone: 314-991-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MYISA WHITLOCK
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 314-400-4051