MEDICARE: LIVING WITH PURPOSE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1952768889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WITH PURPOSE

Provider Business Mailing Address
First Line	:	3919 N 19TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2816
Country	:	US
Telephone Number	:	314-833-4185
Fax Number	:	314-833-4186

Provider Business Practice Location Address
First Line	:	3919 N 19TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2816
Country	:	US
Telephone Number	:	314-833-4185
Fax Number	:	314-833-4186

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CALVIN LEE GARNER
Credential	:
Telephone Number	:	314-833-4185

Provider Enumeration Date	:	01/22/2016
Last Update Date	:	01/22/2016

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Directions to “LIVING WITH PURPOSE ” Practice Location

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