Organization
SUPPORT INDEPENDENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY SHONTEZ MACON (CEO/OWNER)
(314) 504-1459
Entity
Organization
Contact information
Practice address
625 LOYOLA DR, FLORISSANT, MO 63031-7231
(314) 504-1459
Mailing address
625 LOYOLA DR, FLORISSANT, MO 63031-7231
(314) 504-1459
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/11/2016
Last updated
03/11/2016
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