Healthcare Provider Details

I. General information

NPI: 1043813785
Provider Name (Legal Business Name): COMMUNITY RESPONSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 DELMAR BLVD STE 202
SAINT LOUIS MO
63108-1013
US

IV. Provider business mailing address

PO BOX 28961
SAINT LOUIS MO
63132-0961
US

V. Phone/Fax

Practice location:
  • Phone: 314-685-8834
  • Fax: 314-685-8847
Mailing address:
  • Phone: 314-402-2126
  • Fax: 314-685-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BARBARA MCGHEE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LCSW, MPH
Phone: 314-402-2126