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NPI Code Detail

MEDICARE: ST. LOUIS ARC

MEDICARE: ST. LOUIS ARC
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityMO

Other Identifiers

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

General Provider Information

NPI Number : 1194846220
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. LOUIS ARC
Provider Business Mailing Address
First Line : 1816 LACKLAND HILL PKWY STE 200
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3507
Country : US
Telephone Number : 314-569-0778
Fax Number :
Provider Business Practice Location Address
First Line : 1816 LACKLAND HILL PKWY STE 200
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-3507
Country : US
Telephone Number : 314-569-0778
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT OPERATIONS CFO
Name : KATHLEEN TISONE
Credential : CFO
Telephone Number : 314-817-2207
Provider Enumeration Date : 04/03/2007
Last Update Date : 11/29/2007

Similar Medicare Providers

1962688218 — ST. LOUIS ARC
Practice Location Address:
1816 LACKLAND HILL PKWY , VILLA 2
SAINT LOUIS, MO
63146-3507
Practice Phone: 314-569-2211
Practice Fax:
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1816 LACKLAND HILL PKWY , 3272 JANUARY 2
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Practice Fax:
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Practice Location Address:
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SAINT LOUIS, MO
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Practice Fax: 314-569-0778
1700062064 — ST. LOUIS ARC
Practice Location Address:
1816 LACKLAND HILL PKWY , 438 GLAN TAI
SAINT LOUIS, MO
63146-3507
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Practice Fax:
1821274184 — ST. LOUIS ARC
Practice Location Address:
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Practice Fax:
1467638726 — ST. LOUIS ARC
Practice Location Address:
1816 LACKLAND HILL PKWY , 10857 PICCADILLY
SAINT LOUIS, MO
63146-3507
Practice Phone: 314-569-2211
Practice Fax:

Directions to “ST. LOUIS ARC ” Practice Location

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