Organization
HUMBLE ABODE RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANGELA EDWARDS (EXECUTIVE DIRECTOR)
(314) 898-2165
Entity
Organization
Contact information
Practice address
18 S DUCHESNE DR, FLORISSANT, MO 63031-8112
(314) 898-2165
Mailing address
18 S DUCHESNE DR, FLORISSANT, MO 63031-8112
(314) 898-2165
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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