NPI 1780720680

Independence Center

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

Practice location

Address: 19 N Newstead Ave, Saint Louis, MO 63108-2260
Phone: (314) 286-4510
Fax: (314) 286-4565
Mailing address: 4245 Forest Park Ave, Saint Louis, MO 63108-2810

Authorised official

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

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence 033539 (MO)

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

Registry record

NPI: 1780720680
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.