=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114431616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HEIGHTS INTEGRATED HEALTH SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2017
-----------------------------------------------------
Last Update Date | 03/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 REGENCY PARK STE 7
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62269-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-622-3322
-----------------------------------------------------
Fax | 618-622-2229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 REGENCY PARK STE 7
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62269-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-622-3322
-----------------------------------------------------
Fax | 618-622-2229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GABRIELLA L SABATINO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 618-570-9173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------