Organization
ADVANCE WELLNESS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EBONY S HAGENS (OWNER)
(314) 665-9134
Entity
Organization
Contact information
Practice address
7915 OLIVE BLVD, SAINT LOUIS, MO 63130-2020
(314) 665-9134
(314) 453-3897
Mailing address
7915 OLIVE BLVD, SAINT LOUIS, MO 63130-2020
(314) 665-9134
(314) 453-3897
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253J00000X
Foster Care Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
03/10/2025
Last updated
05/08/2025
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