Healthcare Provider Details

I. General information

NPI: 1962796565
Provider Name (Legal Business Name): GIVING CHILDREN A CHANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 WINDING WOODS DR
O FALLON MO
63366-3976
US

IV. Provider business mailing address

139 WINDING WOODS DR
O FALLON MO
63366-3976
US

V. Phone/Fax

Practice location:
  • Phone: 314-406-5209
  • Fax:
Mailing address:
  • Phone: 314-406-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2004022422
License Number StateMO

VIII. Authorized Official

Name: MRS. TRISHA LEA TAYLOR
Title or Position: OWNER
Credential: MOT, OTR-L
Phone: 314-406-5209