| Pasta's Purpose Llc | |
|
219 Eastgate Plz East Alton IL 62024-1077 | |
| (618) 306-9173 | |
| Not Available |
| Full Name | Pasta's Purpose Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 219 Eastgate Plz, East Alton, Illinois |
| Authorized Official Name and Position | Tricia Lynn Hogan (OWNER) |
| Authorized Official Contact | 6185585386 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pasta's Purpose Llc 219 Eastgate Plz East Alton IL 62024-1077 Ph: (618) 306-9173 | Pasta's Purpose Llc 219 Eastgate Plz East Alton IL 62024-1077 Ph: (618) 306-9173 |
| NPI Number | 1720708845 |
|---|---|
| Provider Enumeration Date | 08/30/2022 |
| Last Update Date | 08/30/2022 |
| Certification Date | 08/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720708845 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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