Provider Demographics
NPI:1811620453
Name:MGMLLC
Entity Type:Organization
Organization Name:MGMLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIERATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-294-3012
Mailing Address - Street 1:1715 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1782
Mailing Address - Country:US
Mailing Address - Phone:636-294-3012
Mailing Address - Fax:
Practice Address - Street 1:1715 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1782
Practice Address - Country:US
Practice Address - Phone:636-294-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care