NPI 1770866030

State of Missouri

Organisation Intellectual Disabilities Intermediate Care Facility Saint Louis, MO

Practice location

Address: 10695 Bellefontaine Rd, Saint Louis, MO 63137-2315
Phone: (314) 340-6000
Fax: (314) 340-6199
Mailing address: 1706 E. Elm St. PO Box 687, Jefferson City, MO 65102-0687

Authorised official

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

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X

Other Intermediate Care Facility, Intellectual Disabilities providers in Missouri →

Registry record

NPI: 1770866030
Entity type: Organization
NPI issued: 23 Sep 2011
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.