NPI 1174669006

Independence Center

Organisation Mental Illness Community Based Residential Treatment Facility Saint Louis, MO

Practice location

Address: 2443 Prouhet Ave, Saint Louis, MO 63114-1946
Phone: (314) 890-7100
Fax: (314) 890-7133
Mailing address: 8675 Olive Blvd, Saint Louis, MO 63132-2503

Authorised official

Name: Patricia Holmes
Title: Exectuve Director
Phone: (314) 880-5415

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence 030777 (MO)

Other Community Based Residential Treatment Facility, Mental Illness providers in Missouri →

Registry record

NPI: 1174669006
Entity type: Organization
NPI issued: 29 Jan 2007
Record last updated: 27 Jun 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.