Provider Demographics
NPI:1194219162
Name:INTEGRATED HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH AND WELLNESS LLC
Other - Org Name:WINFIELD RESIDANTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-489-8485
Mailing Address - Street 1:4441 SADDLERIDGE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-6319
Mailing Address - Country:US
Mailing Address - Phone:314-489-8485
Mailing Address - Fax:
Practice Address - Street 1:220 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:MO
Practice Address - Zip Code:63389-1122
Practice Address - Country:US
Practice Address - Phone:636-668-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED HEALTH AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO046210310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility