MEDICARE: JEWISH FAMILY SERVICES OF ST. LOUIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	507352003	MO
3	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114099595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH FAMILY SERVICES OF ST. LOUIS

Provider Business Mailing Address
First Line	:	10950 SCHUETZ RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10950 SCHUETZ RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5704
Country	:	US
Telephone Number	:	314-993-1000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MIRIAM SEIDENFELD
Credential	:
Telephone Number	:	314-812-9379

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	03/17/2020

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