Provider Demographics
NPI:1689098188
Name:VENUS INDEPENDENT LIVING LLC
Entity Type:Organization
Organization Name:VENUS INDEPENDENT LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-422-3877
Mailing Address - Street 1:301 S COFFEY ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:MO
Mailing Address - Zip Code:65582-8862
Mailing Address - Country:US
Mailing Address - Phone:573-422-3877
Mailing Address - Fax:573-422-3496
Practice Address - Street 1:301 S COFFEY ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:MO
Practice Address - Zip Code:65582-8862
Practice Address - Country:US
Practice Address - Phone:573-422-3877
Practice Address - Fax:573-422-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251S00000X, 320900000X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities