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General NPI Number Information
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NPI Number | 1316328800
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Entity Type | Organization
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Legal Business Name | SUSTAS HEALTH SOLUTIONS LLC
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 625 N EUCLID AVE STE 330D
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1690
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Country | US
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Telephone | 314-833-5940
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Fax | 314-833-5941
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Provider Business Mailing Address
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Address Line | 625 N EUCLID AVE STE 330D
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1690
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Country | US
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Telephone | 314-833-5940
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Fax | 314-833-5941
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. TRACY MAYS
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Credential |
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Telephone | 314-556-9812
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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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