Organization
SUPPORT FOR INDEPENDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
UNIQUE MACON (PRESIDENT)
(314) 504-1459
Entity
Organization
Contact information
Practice address
1419 DEVONSHIRE COUNTY DR, WENTZVILLE, MO 63385-4349
(314) 504-1459
Mailing address
1419 DEVONSHIRE COUNTY DR, WENTZVILLE, MO 63385-4349
(314) 504-1459
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
03/05/2018
Last updated
06/11/2019
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