Healthcare Provider Details

I. General information

NPI: 1932271475
Provider Name (Legal Business Name): SIENNA HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 LEROY AVE
SAINT LOUIS MO
63133-1504
US

IV. Provider business mailing address

1322 LEROY AVE
ST LOUIS MO
63133-1504
US

V. Phone/Fax

Practice location:
  • Phone: 314-721-1389
  • Fax: 314-721-3237
Mailing address:
  • Phone: 314-721-1389
  • Fax: 314-721-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number031868
License Number StateMO

VIII. Authorized Official

Name: MS. MAE NMN PETERS
Title or Position: MANAGER
Credential:
Phone: 314-721-1289