Provider Demographics
NPI:1316914252
Name:RICKLENE ENTERPRISES CORP
Entity type:Organization
Organization Name:RICKLENE ENTERPRISES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-361-6240
Mailing Address - Street 1:4960 LACLEDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1404
Mailing Address - Country:US
Mailing Address - Phone:314-361-6240
Mailing Address - Fax:314-361-6682
Practice Address - Street 1:4960 LACLEDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1404
Practice Address - Country:US
Practice Address - Phone:314-361-6240
Practice Address - Fax:314-361-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12960519332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0897670001Medicare ID - Type Unspecified