NPI 1235428095
Community Supportive Services
Practice location
- Address
- 3520 Hampton Ave, St Louis, MO 63139-1918
- Phone
- (314) 454-1219
- Fax
- (314) 454-1382
- Mailing address
- 3520 Hampton Ave, Saint Louis, MO 63139-1918
Authorised official
- Name
- Isaac Onyema
- Title
- Director
- Phone
- (314) 454-1219
Registered specialties
Mental Illness Community Based Residential Treatment Facility
Primary
Registry record
- NPI
- 1235428095
- Entity type
- Organization
- NPI issued
- 1 Apr 2011
- Record last updated
- 1 Apr 2011
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.