NPI 1508308578

Isaiah's Angels LLC

Organisation Preferred Provider Organization Saint Louis, MO

Practice location

Address: 5261 Delmar Blvd Suite 210b, Saint Louis, MO 63108-1063
Phone: (314) 322-3994
Mailing address: 8739 Agate CT, Saint Louis, MO 63136-3700

Authorised official

Name: Carolyn Warren
Title: Director
Phone: (314) 322-3994

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence LC9814999 (MO)

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Registry record

NPI: 1508308578
Entity type: Organization
NPI issued: 8 Nov 2016
Record last updated: 8 Nov 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.