Grace Hill Neighborhood Health Ctr

Organization Active NPI Pediatric Nutrition Registered Dietitian · Saint Louis, MO

NPI 1295068757 · NPPES record last updated Sep 15, 2009

Key facts

NPI
1295068757
Entity type
Organization (NPI type 2)
Primary specialty
Pediatric Nutrition Registered Dietitian 133VN1004X
License
2009014930 (MO)
Legal business name
GRACE HILL NEIGHBORHOOD HEALTH CTR
Practice address
2220 Lemp Ave
Saint Louis, MO 63104-2700
Phone
(314) 814-8556
Fax
(314) 814-8542
NPI assigned
Sep 15, 2009
Organization subpart
No

Authorized official

Name
Mary Lucca
Title
Licensed Dietitian
Phone
(314) 814-8556

Corporate family (same tax ID) 20

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Affinia Healthcare (21 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nutrition Registered Dietitian
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
133VN1004X 2009014930 MO Yes
Local Education Agency (LEA) 251300000X

Addresses

Primary practice location

2220 Lemp Ave
Saint Louis, MO 63104-2700

Mailing address

2220 Lemp Ave
Saint Louis, MO 63104-2700
Phone (314) 814-8556

Other providers in Saint Louis, MO

All providers in Saint Louis, MO · Pediatric Nutrition Registered Dietitian in Missouri

Sources for this page

Verify at the official NPI Registry.