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General NPI Number Information
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NPI Number | 1790343804
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Entity Type | Individual
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Provider Name | CALVIN AKINS
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 4432 W BELLE PL
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2617
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Country | US
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Telephone | 314-652-8908
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Fax | 314-652-8819
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Provider Business Mailing Address
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Address Line | 4432 W BELLE PL
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2617
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Country | US
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Telephone | 314-652-8908
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Fax | 314-652-8819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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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 | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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