Healthcare Provider Details

I. General information

NPI: 1346620333
Provider Name (Legal Business Name): COMMUNITY BEHAVIOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S VANDEVENTER AVE FL 2
SAINT LOUIS MO
63110-3856
US

IV. Provider business mailing address

957 WHISPERING RIDGE LN
SAINT PETERS MO
63376-5523
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-0804
  • Fax:
Mailing address:
  • Phone: 314-556-4443
  • Fax: 636-244-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. NAIM MUHAMMAD
Title or Position: DIRECTOR
Credential:
Phone: 314-556-4443