NPI 1487721379

State of Missouri

Organisation Psychiatric Residential Treatment Facility Saint Louis, MO

Practice location

Address: 1901 Pennsylvania Ave, Saint Louis, MO 63133-1325
Phone: (314) 512-7609
Fax: (314) 512-7812
Mailing address: 1706 E Elm St, Jefferson City, MO 65101-4130

Authorised official

Name: Molly Jane Boeckmann
Title: Director of Administrative Services
Phone: (573) 751-4055

Registered specialties

Psychiatric Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 323P00000X

Other Psychiatric Residential Treatment Facility providers in Missouri →

Registry record

NPI: 1487721379
Entity type: Organization
NPI issued: 29 Nov 2006
Record last updated: 27 Oct 2020

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.