Provider Demographics
NPI:1346820123
Name:REZILIENT OLH PA
Entity Type:Organization
Organization Name:REZILIENT OLH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CALLISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-328-8331
Mailing Address - Street 1:5595 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1703
Mailing Address - Country:US
Mailing Address - Phone:314-912-4234
Mailing Address - Fax:314-887-5159
Practice Address - Street 1:7923 FORSYTH BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3808
Practice Address - Country:US
Practice Address - Phone:314-912-4234
Practice Address - Fax:314-887-5157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPENLOOP HEALTHCARE PARTNERS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-14
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty