MEDICARE: PRESBYTERIAN CHILDREN'S SERVICES, INC.

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

General Provider Information

NPI Number	:	1811178585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN CHILDREN'S SERVICES, INC.

Provider Business Mailing Address
First Line	:	1353 N WARSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1807
Country	:	US
Telephone Number	:	314-989-9727
Fax Number	:	314-989-9709

Provider Business Practice Location Address
First Line	:	2740 E PYTHIAN ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65802-2303
Country	:	US
Telephone Number	:	417-862-9634
Fax Number	:	417-865-6507

Authorized Official
Title or Position	:	EXECUTIVE VP-PROGRAM
Name	:	MR. ROBERT GIEGLING
Credential	:	MA
Telephone Number	:	314-989-9727

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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