Healthcare Provider Details

I. General information

NPI: 1275673535
Provider Name (Legal Business Name): SUPPORT INNOVATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 DAUTEL LN
SAINT LOUIS MO
63146-5533
US

IV. Provider business mailing address

13422 CLAYTON RD SUITE 214
SAINT LOUIS MO
63131-1008
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-0588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number644
License Number StateMO

VIII. Authorized Official

Name: MRS. ANNA KLEINLEIN
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 314-205-0588