Provider Demographics
NPI:1982477212
Name:SWEET PEACE BALANCE LLC
Entity Type:Organization
Organization Name:SWEET PEACE BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-791-5219
Mailing Address - Street 1:118 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4008
Mailing Address - Country:US
Mailing Address - Phone:314-791-5219
Mailing Address - Fax:
Practice Address - Street 1:118 W JEFFERSON AVE.
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-791-5219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty