Healthcare Provider Details

I. General information

NPI: 1669846101
Provider Name (Legal Business Name): ST. LOUIS EFFORT FOR AIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S VANDEVENTER AVE SUITE 700
SAINT LOUIS MO
63110-3800
US

IV. Provider business mailing address

1027 S VANDEVENTER AVE SUITE 700
SAINT LOUIS MO
63110-3800
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-6451
  • Fax: 314-645-6502
Mailing address:
  • Phone: 314-645-6451
  • Fax: 314-645-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DALE WRIGLEY
Title or Position: MANAGER
Credential:
Phone: 314-645-6451