=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043962327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEAVES SPEAK HEALTHCARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2022
-----------------------------------------------------
Last Update Date | 01/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 S MERAMEC AVE STE 202
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-3514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-304-2051
-----------------------------------------------------
Fax | 314-298-8818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 S MERAMEC AVE STE 202
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-3514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-304-2051
-----------------------------------------------------
Fax | 314-298-8818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. MAURYA COCKRELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-882-0382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------