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General NPI Number Information
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NPI Number | 1295592343
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Entity Type | Organization
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Legal Business Name | ENHANCED WELLNESS LLC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 4200 UNION BLVD STE 107
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1140
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Country | US
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Telephone | 314-925-8279
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Fax | 314-925-8297
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Provider Business Mailing Address
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Address Line | 4200 UNION BLVD STE 107
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1140
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Country | US
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Telephone | 314-925-8279
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Fax | 314-925-8297
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Authorized Official
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Title or Position | OWNER
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Name | DAMON SULLIVAN
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Credential |
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Telephone | 314-925-8279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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