Provider Demographics
NPI:1932590510
Name:LIVE AT PEACE MINISTRIES
Entity Type:Organization
Organization Name:LIVE AT PEACE MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF ACCOUNTING AND ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KYRSTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-479-9028
Mailing Address - Street 1:11469 OLIVE BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7108
Mailing Address - Country:US
Mailing Address - Phone:314-479-9028
Mailing Address - Fax:
Practice Address - Street 1:11780 BORMAN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4135
Practice Address - Country:US
Practice Address - Phone:314-479-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health