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General NPI Number Information
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NPI Number | 1174298483
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Entity Type | Organization
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Legal Business Name | GWD ASSISTED LIVING LLC
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 11423 SAINT CHARLES ROCK RD
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City | HAZELWOOD
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State | MO
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Zip | 63044-2724
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Country | US
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Telephone | 314-246-9852
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Fax |
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Provider Business Mailing Address
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Address Line | 11423 SAINT CHARLES ROCK RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2724
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Country | US
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Telephone | 314-246-9852
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MRS. VERNISIA WHITE
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Credential |
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Telephone | 314-246-9852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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