Organization
MARDRAS MARVELOUS MISSION I LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNICE SHELTON BSN RN (EXECUTIVE DIRECTOR)
(314) 659-9090
Entity
Organization
Contact information
Practice address
3830 WASHINGTON BLVD, STE 109, SAINT LOUIS, MO 63108-3460
(314) 659-9090
(314) 833-3170
Mailing address
3830 WASHINGTON BLVD, STE 109, SAINT LOUIS, MO 63108-3460
(636) 465-3004
(314) 833-3170
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DHSS
—
MO
Enumeration date
07/29/2015
Last updated
08/28/2016
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