MEDICARE: LIVE AT PEACE MINISTRIES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1932590510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE AT PEACE MINISTRIES

Provider Business Mailing Address
First Line	:	11469 OLIVE BLVD STE 217
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7108
Country	:	US
Telephone Number	:	314-479-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	11780 BORMAN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4135
Country	:	US
Telephone Number	:	314-479-9028
Fax Number	:

Authorized Official
Title or Position	:	MANAGER OF ACCOUNTING AND ADMIN
Name	:	KYRSTAN LANGER
Credential	:
Telephone Number	:	314-479-9028

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	02/18/2015

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Directions to “LIVE AT PEACE MINISTRIES ” Practice Location

Language	Start Address	Practice Location

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