Healthcare Provider Details

I. General information

NPI: 1356698930
Provider Name (Legal Business Name): JAMIESON CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 JAMIESON AVE
SAINT LOUIS MO
63109-1109
US

IV. Provider business mailing address

3715 JAMIESON AVE
SAINT LOUIS MO
63109-1109
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-0222
  • Fax: 888-836-1101
Mailing address:
  • Phone: 314-781-0222
  • Fax: 888-836-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number040469
License Number StateMO

VIII. Authorized Official

Name: JAMES HERBST
Title or Position: MANAGER
Credential:
Phone: 636-448-3781