Provider Demographics
NPI:1386257780
Name:EUSTASIS FOUNDATION, INC
Entity type:Organization
Organization Name:EUSTASIS FOUNDATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:BREANNA
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, CARN-AP, A
Authorized Official - Phone:417-322-6622
Mailing Address - Street 1:3600 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7311
Mailing Address - Country:US
Mailing Address - Phone:417-322-6622
Mailing Address - Fax:417-350-1935
Practice Address - Street 1:3100 S NATIONAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7347
Practice Address - Country:US
Practice Address - Phone:417-427-6103
Practice Address - Fax:417-350-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable