Healthcare Provider Details

I. General information

NPI: 1487132015
Provider Name (Legal Business Name): SSM HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST CAPITOL DR
SAINT CHARLES MO
63301-2844
US

IV. Provider business mailing address

300 1ST CAPITOL DR
SAINT CHARLES MO
63301-2844
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5040
  • Fax:
Mailing address:
  • Phone: 636-947-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANASTASIA NORVILLE
Title or Position: SOCIAL WORKER
Credential: MSW, LMSW
Phone: 309-235-2763