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NPI Code Detail

MEDICARE: UNFAILING LOVE CRC (COMMUNITY RESOURCE CENTER)

MEDICARE: UNFAILING LOVE CRC (COMMUNITY RESOURCE CENTER)
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1497585301
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNFAILING LOVE CRC (COMMUNITY RESOURCE CENTER)
Provider Business Mailing Address
First Line : 15563 CHASTE ST
Second Line :
City : FLORISSANT
State : MO
Zip : 63034-2173
Country : US
Telephone Number : 314-226-9705
Fax Number :
Provider Business Practice Location Address
First Line : 4068 MAFFITT AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63113-3235
Country : US
Telephone Number : 314-226-9705
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : JASON ALLEN BARNEY SR.
Credential :
Telephone Number : 314-604-4561
Provider Enumeration Date : 08/05/2024
Last Update Date : 08/05/2024

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Directions to “UNFAILING LOVE CRC (COMMUNITY RESOURCE CENTER) ” Practice Location

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