Provider Demographics
NPI:1447034723
Name:FILLING THE GAP LLC
Entity type:Organization
Organization Name:FILLING THE GAP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECECTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RESHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-397-7625
Mailing Address - Street 1:231 S BEMISTON AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1925
Mailing Address - Country:US
Mailing Address - Phone:314-397-7625
Mailing Address - Fax:
Practice Address - Street 1:231 S BEMISTON AVE STE 800
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1925
Practice Address - Country:US
Practice Address - Phone:314-397-7625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health