Healthcare Provider Details

I. General information

NPI: 1447628334
Provider Name (Legal Business Name): JPAM CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 LELAND AVE
SAINT LOUIS MO
63130-3239
US

IV. Provider business mailing address

12832 BIG BEND RD
SAINT LOUIS MO
63122-5104
US

V. Phone/Fax

Practice location:
  • Phone: 314-726-4767
  • Fax:
Mailing address:
  • Phone: 314-374-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN BRENCICK
Title or Position: PRESIDENT
Credential:
Phone: 314-374-7419