Full Potential Residential Services, Llc

NPI 1730337114 - Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities - 320900000X

NPI Details
NPI 1730337114
Enumeration Date 08/28/2008
Last Updated 08/28/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name DEMETRA EVON DEMETRA
Position ADMINISTRATOR
Phone (314) 839-9157
Fax (314) 839-9157
Practice Location
8208 PAGE AVE
SAINT LOUIS MO, 63130-1115, US
Phone (314) 839-9157
Fax (314) 839-9157
Business Location
2335 INDIANCUP DR
FLORISSANT MO, 63033-1736, US
Phone (314) 839-9157
Fax
Toxanomy
Taxonomy Code 320900000X
License State Missouri
License Number 2006031224
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According to our database, Full Potential Residential Services, Llc NPI is 1730337114, taxonomy code is 320900000X and license number is 2006031224, license state is located at Missouri. Full Potential Residential Services, Llc physically located at 8208 Page Ave, Saint Louis MO, 63130-1115. NPI Number 1033115704 has the healthcare provider type.

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1730337114 NPI number is provided on an as is basis without warranty of any kind. 1730337114 is maintained by the National Plan & Provider Enumeration System. The contents of Full Potential Residential Services, Llc are for informational purposes only.