Provider Demographics
NPI:1619515665
Name:PEOPLE OVERCOMING WITH EVERLASTING RESULTS, INC.
Entity Type:Organization
Organization Name:PEOPLE OVERCOMING WITH EVERLASTING RESULTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:618-514-6310
Mailing Address - Street 1:5731 MOUNT PLEASANT LN UNIT 24355
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5167
Mailing Address - Country:US
Mailing Address - Phone:618-514-6310
Mailing Address - Fax:
Practice Address - Street 1:6400 W MAIN ST STE 1F-3
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3806
Practice Address - Country:US
Practice Address - Phone:314-270-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9761303Medicaid