Organization
COMPREHENSIVE INDEPENDENT GOALS INC ST. LOUIS CONSUMER DIRECTED SERVIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE MAX MCGOWAN (PRES./C. F. O.)
(314) 361-7337
Entity
Organization
Contact information
Practice address
40 N KINGSHIGHWAY BLVD, SUITE - 6, SAINT LOUIS, MO 63108-1378
(314) 361-7337
(314) 361-3361
Mailing address
PO BOX 66037, BATON ROUGE, LA 70896-6037
(225) 926-5190
(225) 926-6964
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104137041
—
MO
05
—
1157384
—
LA
05
—
1157392
—
LA
05
—
1173835
—
LA
05
—
1642649
—
LA
Enumeration date
05/08/2012
Last updated
05/08/2012
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