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General NPI Number Information
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NPI Number | 1154788156
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Entity Type | Organization
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Legal Business Name | PROMISE MOBILITY LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 5 S NEWSTEAD AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2213
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Country | US
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Telephone | 314-302-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 5 S NEWSTEAD AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES H FELKER
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Credential |
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Telephone | 314-302-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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