Affinia Healthcare
Clinic/Center, Federally Qualified Health Center (FQHC) in Saint Louis, MO. Organization (NPI-2).
NPI number1871069062
StatusActive
Last updated in NPPESOct 16, 2018
Details
- NPI
- 1871069062
- Entity type
- Organization (NPI-2)
- Legal business name
- Affinia Healthcare
- Organization subpart
- No
- Enumeration date
- Oct 16, 2018
- Last updated
- Oct 16, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
Other names
- Lift For Life Academy (Doing Business As)
Practice location
1731 S BroadwaySaint Louis, MO 63104-4050
Phone 314-814-8700 · Fax 314-814-8542
Mailing address
Po Box 551Saint Louis, MO 63188-0551
Phone 314-814-8531 · Fax 314-814-8542
Authorized official
Corinthia Darcel Jamison
Credentialing Coordinator
3148148531
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All 45 Federally Qualified Health Center (FQHC) providers in Saint Louis · All 34,755 providers in Saint Louis
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