Organization
MAKEOVER FOR LIFE OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA ROCHELLE MOORE CASAC2,CCJP,SATOP,CC (CEO)
(314) 382-6090
Entity
Organization
Contact information
Practice address
4730 MARGARETTA AVE FL 2, SAINT LOUIS, MO 63115-2151
(314) 382-6090
Mailing address
4730 MARGARETTA AVE FL 2, SAINT LOUIS, MO 63115-2151
(314) 382-6090
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
#2955 & #3100
MO
Other
Enumeration date
12/10/2010
Last updated
12/10/2010
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