Organization
I-WAVE
Active
Organization
I-WAVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMERIA D SPEARMAN (CEO/DIRECTOR)
(380) 867-1900
Entity
Organization
Contact information
Practice address
10995 CHASE PARK LN APT C, SAINT LOUIS, MO 63141-5787
(314) 441-9488
(844) 378-5562
Mailing address
PO BOX 410708, SAINT LOUIS, MO 63141-0708
(380) 867-1900
(844) 378-5562
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/16/2019
Last updated
07/16/2019
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