Healthcare Provider Details

I. General information

NPI: 1245357599
Provider Name (Legal Business Name): MBCH CHILDREN AND FAMILY MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2721
US

IV. Provider business mailing address

11300 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2721
US

V. Phone/Fax

Practice location:
  • Phone: 314-739-6811
  • Fax: 314-739-6325
Mailing address:
  • Phone: 314-739-6811
  • Fax: 314-739-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number00NA
License Number State

VIII. Authorized Official

Name: MR. RUSSELL MARTIN
Title or Position: PRESIDENT AND TREASURER
Credential:
Phone: 314-739-6811