Provider Demographics
NPI:1487150843
Name:INTEGRATED HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-489-8485
Mailing Address - Street 1:4441 SADDLERIDGE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-6319
Mailing Address - Country:US
Mailing Address - Phone:314-489-8485
Mailing Address - Fax:
Practice Address - Street 1:119 W CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1605
Practice Address - Country:US
Practice Address - Phone:573-324-5560
Practice Address - Fax:573-324-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO046117310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility