Healthcare Provider Details

I. General information

NPI: 1093651150
Provider Name (Legal Business Name): 12 AND BEYOND MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HAMPTON AVE
SAINT LOUIS MO
63109-2718
US

IV. Provider business mailing address

4700 HAMPTON AVE
SAINT LOUIS MO
63109-2718
US

V. Phone/Fax

Practice location:
  • Phone: 602-816-9421
  • Fax: 954-301-8110
Mailing address:
  • Phone: 602-816-9421
  • Fax: 954-301-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER GIFFORD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-816-9421