MEDICARE: JEWISH COMMUNITY CENTER

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	1036	MO
2	261QA0600X	Adult Day Care Clinic/Center	584	MO

General Provider Information

NPI Number	:	1275759144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	2 MILLSTONE CAMPUS DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5776
Country	:	US
Telephone Number	:	314-432-5700
Fax Number	:	314-872-7189

Provider Business Practice Location Address
First Line	:	2 MILLSTONE CAMPUS DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-5776
Country	:	US
Telephone Number	:	314-432-5700
Fax Number	:	314-872-7189

Authorized Official
Title or Position	:	COO
Name	:	NICOLE L HAWKINS
Credential	:
Telephone Number	:	314-442-3148

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	02/12/2026

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Directions to “JEWISH COMMUNITY CENTER ” Practice Location

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