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NPI Code Detail

MEDICARE: PURE LIVING RECOVERY AND REHABILITION CENTER

MEDICARE: PURE LIVING RECOVERY AND REHABILITION 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1992556773
Entity Type Code : Organization
Provider Name (Legal Business Name) : PURE LIVING RECOVERY AND REHABILITION CENTER
Provider Business Mailing Address
First Line : 5601 STATE ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1346
Country : US
Telephone Number : 314-701-0405
Fax Number :
Provider Business Practice Location Address
First Line : 5601 STATE ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62203-1346
Country : US
Telephone Number : 314-701-0405
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : REGINALD DEMARIAL SMITH
Credential :
Telephone Number : 314-701-0405
Provider Enumeration Date : 03/29/2024
Last Update Date : 03/29/2024

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Directions to “PURE LIVING RECOVERY AND REHABILITION CENTER ” Practice Location

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