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General NPI Number Information
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NPI Number | 1740770049
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Entity Type | Organization
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Legal Business Name | DEISTER VENTURES LLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 16512 CENTERPOINTE DR
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City | WILDWOOD
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State | MO
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Zip | 63040-1608
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Country | US
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Telephone | 314-578-4366
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Fax |
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Provider Business Mailing Address
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Address Line | 16512 CENTERPOINTE DR
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City | WILDWOOD
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State | MO
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Zip | 63040-1608
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Country | US
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Telephone | 314-578-4366
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOHN MELVIN DEISTER JR.
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Credential |
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Telephone | 314-578-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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