Healthcare Provider Details

I. General information

NPI: 1861763047
Provider Name (Legal Business Name): MIDWEST HOUSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 MCKELVEY RD SUITE 103
BRIDGETON MO
63044
US

IV. Provider business mailing address

3394 MCKELVEY RD SUITE 103
BRIDGETON MO
63044
US

V. Phone/Fax

Practice location:
  • Phone: 314-731-1922
  • Fax:
Mailing address:
  • Phone: 314-731-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE SAURBERRY
Title or Position: MEMBER
Credential:
Phone: 314-731-1922