NPI 1861782898
N/A
Practice location
- Address
- 1318 Pennsylvania Ave, Saint Louis, MO 63133-1036
- Phone
- (314) 401-1466
- Mailing address
- 1318 Pennsylvania Ave, Pagedale, MO 63133-1036
Authorised official
- Name
- Gloria Jean Patrick
- Title
- Home Aid
- Phone
- (314) 401-1466
Registered specialties (3)
Psychiatric Residential Treatment Facility
Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Physical Disabilities Residential Treatment Facility
Registry record
- NPI
- 1861782898
- Entity type
- Organization
- NPI issued
- 11 Apr 2011
- Record last updated
- 11 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.