Healthcare Provider Details

I. General information

NPI: 1962083493
Provider Name (Legal Business Name): REM MISSOURI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11872 WESTLINE INDUSTRIAL DR STE 100
SAINT LOUIS MO
63146-3331
US

IV. Provider business mailing address

11872 WESTLINE INDUSTRIAL DR STE 100
SAINT LOUIS MO
63146-3331
US

V. Phone/Fax

Practice location:
  • Phone: 660-815-4997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL KRAMER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-815-4997