Provider Demographics
NPI:1194135897
Name:GRAND HEALTH WELLNESS & ACUPUNCTURE LLC
Entity type:Organization
Organization Name:GRAND HEALTH WELLNESS & ACUPUNCTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-690-1525
Mailing Address - Street 1:4800 MEXICO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1666
Mailing Address - Country:US
Mailing Address - Phone:314-690-1525
Mailing Address - Fax:636-442-5036
Practice Address - Street 1:4800 MEXICO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1666
Practice Address - Country:US
Practice Address - Phone:314-690-1525
Practice Address - Fax:636-442-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006033498261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service