ADVANCE WELLNESS GROUP LLC NPI 1093514200

NPI Information

  • NPI: 1093514200
  • Provider Name: ADVANCE WELLNESS GROUP LLC
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Organization
  • Address: 7915 OLIVE BLVD
    SAINT LOUIS, MO
    ZIP 63130
  • Phone: (314) 665-9134

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NPI Details

ADVANCE WELLNESS GROUP LLC is a community based residential treatment facility, intellectual and/or developmental disabilities in Saint Louis, MO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. ADVANCE WELLNESS GROUP LLC NPI is 1093514200. The provider is registered as an organization entity type.

The provider's business location address is:

7915 OLIVE BLVD
SAINT LOUIS, MO
ZIP 63130-020
Phone: (314) 665-9134
Fax: (314) 453-3897

The provider's authorized official is Ebony S Hagens .
The authorized official title is Owner and has the following contact phone number (314) 665-9134.

The enumeration date for this NPI number is 3/10/2025 and was last updated on 5/8/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251E00000XHome HealthNo
2253J00000XFoster Care AgencyNo
3320600000XResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesNo
4320700000XResidential Treatment Facility, Physical DisabilitiesNo
5385H00000XRespite CareNo
6385HR2060XRespite CareRespite Care, Intellectual and/or Developmental DisabilitiesNo
7320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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