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General NPI Number Information
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NPI Number | 1235750514
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Entity Type | Organization
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Legal Business Name | SOCIETY OF GOOD SHEPHERD
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 3149 MERAMEC ST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-4338
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Country | US
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Telephone | 314-403-4368
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Fax |
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Provider Business Mailing Address
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Address Line | 3149 MERAMEC ST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-4338
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Country | US
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Telephone | 314-403-4368
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEANETTE AMLETTE
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Credential |
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Telephone | 314-403-4368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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