=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841539970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANOINTED SEASONED ADULTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2013
-----------------------------------------------------
Last Update Date | 02/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8368 LATTY AVE
-----------------------------------------------------
City | HAZELWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63042-3236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-524-9004
-----------------------------------------------------
Fax | 314-524-4271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15666 DEBRIDGE WAY
-----------------------------------------------------
City | FLORISSANT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63034-3481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-524-9004
-----------------------------------------------------
Fax | 314-524-4271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. JANET I STRICKLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-524-9004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 1091
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------