Provider Demographics
NPI:1710310909
Name:PROMISE HEALTHCARE CENTER
Entity Type:Organization
Organization Name:PROMISE HEALTHCARE CENTER
Other - Org Name:PROMISE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-234-4076
Mailing Address - Street 1:2621 LISA LN
Mailing Address - Street 2:209
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-3477
Mailing Address - Country:US
Mailing Address - Phone:636-234-4076
Mailing Address - Fax:
Practice Address - Street 1:2621 LISA LN
Practice Address - Street 2:209
Practice Address - City:PACIFIC
Practice Address - State:MO
Practice Address - Zip Code:63069-3477
Practice Address - Country:US
Practice Address - Phone:636-234-4076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health