Provider Demographics
NPI:1467005744
Name:I-WAVE
Entity Type:Organization
Organization Name:I-WAVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMERIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:380-867-1900
Mailing Address - Street 1:PO BOX 410708
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-0708
Mailing Address - Country:US
Mailing Address - Phone:380-867-1900
Mailing Address - Fax:844-378-5562
Practice Address - Street 1:10995 CHASE PARK LN APT C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5787
Practice Address - Country:US
Practice Address - Phone:314-441-9488
Practice Address - Fax:844-378-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility