MEDICARE: WALKNFAITH CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1255089587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALKNFAITH CLINIC

Provider Business Mailing Address
First Line	:	2386 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-2034
Country	:	US
Telephone Number	:	314-260-9097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2386 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-2034
Country	:	US
Telephone Number	:	314-260-9097
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SABRINA DAVIS
Credential	:
Telephone Number	:	314-323-7116

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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