Pure Living Recovery and Rehabilition Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PURE LIVING RECOVERY AND REHABILITION CENTER

Practice address

5601 State St
East Saint Louis, IL 62203-1346

Phone

(314) 701-0405

NPI assigned

Mar 29, 2024

Organization subpart

Yes

Parent organization

PURE LIVING RECOVERY AND REHABILITATION CENTERAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Reginald Demarial Smith

Title

Executive Director

Phone

(314) 701-0405

Specialties & licenses 1

Addresses

Part of

Pure Living Recovery and Rehabilition Center

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1992556773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622031346",
            "telephone_number": "314-701-0405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622031346",
            "telephone_number": "314-701-0405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE LIVING RECOVERY AND REHABILITION CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PURE LIVING RECOVERY AND REHABILITATION CENTER",
        "enumeration_date": "2024-03-29",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "DEMARIAL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-701-0405"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Yvonne Pettiford, LPC
• Verna J. Porter, MD
• Adam Pruett, RDN
• Kayla Ann Pryor, APRN
• Leah Pulley
• Quality Home Care Solutions Inc
• Jewel Radford, RN
• Roadside Medical, LLC
• Karnaldo Ross
• Songyoth Sakdisri, MD

• Community/Behavioral Health Agency in East Saint Louis, IL
• Providers in East Saint Louis, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.