MEDICARE: THE CHILDREN'S HOME SOCIETY OF MISSOURI

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		MO
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1285752378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDREN'S HOME SOCIETY OF MISSOURI

Provider Business Mailing Address
First Line	:	9445 LITZSINGER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2113
Country	:	US
Telephone Number	:	314-968-2350
Fax Number	:	314-968-4239

Provider Business Practice Location Address
First Line	:	9445 LITZSINGER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2113
Country	:	US
Telephone Number	:	314-968-2350
Fax Number	:	314-968-4239

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS & FINANCE
Name	:	MR. LARRY DUKE
Credential	:
Telephone Number	:	314-968-2350

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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Directions to “THE CHILDREN'S HOME SOCIETY OF MISSOURI ” Practice Location

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