Organization
ICU CDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NYAKIO POWELL (OWNER)
(314) 550-1184
Entity
Organization
Contact information
Practice address
4069 ASHBURY CROSSING DR, FLORISSANT, MO 63034
(314) 550-1184
Mailing address
4069 ASHBURY CROSSING DR, FLORISSANT, MO 63034-2884
(314) 550-1184
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83060235
—
MO
Enumeration date
06/25/2018
Last updated
10/20/2020
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