Healthcare Provider Details

I. General information

NPI: 1184266314
Provider Name (Legal Business Name): THE BRAIN INJURY FOUNDATION OF ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 MANCHESTER RD
SAINT LOUIS MO
63143-2710
US

IV. Provider business mailing address

7850 MANCHESTER RD
SAINT LOUIS MO
63143-2710
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-7230
  • Fax: 844-527-4893
Mailing address:
  • Phone: 314-645-7230
  • Fax: 844-527-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH ANN DAVIS
Title or Position: DIRECTOR OF CLIENT SERVICES
Credential: CBIST
Phone: 314-645-7230