Healthcare Provider Details

I. General information

NPI: 1992949986
Provider Name (Legal Business Name): EMMANUEL OUTREACH MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 BISSELL ST
SAINT LOUIS MO
63107-1406
US

IV. Provider business mailing address

2125 BISSELL ST
SAINT LOUIS MO
63107-1406
US

V. Phone/Fax

Practice location:
  • Phone: 314-533-4225
  • Fax:
Mailing address:
  • Phone: 314-533-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROBERT PARISH
Title or Position: DIRECTOR
Credential:
Phone: 314-533-4225