Healthcare Provider Details

I. General information

NPI: 1619730876
Provider Name (Legal Business Name): THE REFUGE THERAPEUTIC SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 S NATIONAL AVE STE C1
SPRINGFIELD MO
65810-2895
US

IV. Provider business mailing address

4650 S NATIONAL AVE STE C1
SPRINGFIELD MO
65810-2895
US

V. Phone/Fax

Practice location:
  • Phone: 660-243-4363
  • Fax:
Mailing address:
  • Phone: 660-243-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHERRIE WALLACE
Title or Position: MANAGER
Credential:
Phone: 801-726-9573