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Organization

PROVIDER PLUS, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WENDY RUSSALESI (CCO)
(484) 246-9499
Entity
Organization

Contact information

Practice address
7748 WATSON RD, SAINT LOUIS, MO 63119-5407
(314) 961-8500
(314) 963-6801
Mailing address
555 E NORTH LN STE 5075, CONSHOHOCKEN, PA 19428-2490

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MO
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
623407509
MO
05
91633002
TX
Enumeration date
08/03/2005
Last updated
10/15/2025
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