Organization
AFFINIA HEALTHCARE
Active
Other names
Lift for Life Academy
Organization subpart
No
Provider details
NPI number
Authorized official
CORINTHIA DARCEL JAMISON (CREDENTIALING COORDINATOR)
(314) 814-8531
Entity
Organization
Contact information
Practice address
1731 S BROADWAY, SAINT LOUIS, MO 63104-4050
(314) 814-8700
(314) 814-8542
Mailing address
PO BOX 551, SAINT LOUIS, MO 63188-0551
(314) 814-8531
(314) 814-8542
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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