MEDICARE: CENTREC CARE

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	3140-9189	MO

General Provider Information

NPI Number	:	1821019936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTREC CARE

Provider Business Mailing Address
First Line	:	1224 FERN RIDGE PKWY
Second Line	:	SUITE 305
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-4404
Country	:	US
Telephone Number	:	314-205-8068
Fax Number	:	314-469-4507

Provider Business Practice Location Address
First Line	:	1224 FERN RIDGE PKWY
Second Line	:	SUITE 305
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-4404
Country	:	US
Telephone Number	:	314-205-8068
Fax Number	:	314-469-4507

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	COLLEEN TILFORD
Credential	:
Telephone Number	:	314-205-8068

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/01/2013

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Directions to “CENTREC CARE ” Practice Location

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