Mind Body Endurance Llc

LBN: Mind Body Endurance Llc
Mind Body Endurance Llc is an health care organization with primary practice located at 16 N Gore Ave Ste 204 , Saint Louis MO 63119-2315. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Exercise & Sports, which is considered as the primary health care specialty. Mind Body Endurance Llc can be contacted via phone (513) 505-2160, or through Nickols, Riley via phone (513) 505-2160.

Contact Information

Primary practice address
16 N Gore Ave Ste 204 Saint Louis MO 63119-2315
Phone: (513) 505-2160
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Nickols, Riley PHD
Phone: (513) 505-2160

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Exercise & Sports 103TE1100X

Profile Details

NPI number 1053018903
LBN Legal business name Mind Body Endurance Llc
DBA Doing business as
Authorized official Nickols, Riley PHD
Entity Organization
Organization subpart 1 No
Enumeration date Feb 10th, 2023
Last updated Feb 10th, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053018903 NPPES
Missouri MEDICAID 1790019511

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