Healthcare Provider Details

I. General information

NPI: 1942484266
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY HEARTLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 08/19/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 OLD BONHOMME RD UNITED CEREBRAL PALSY OF GREATER ST. LOUIS
SAINT LOUIS MO
63132-3999
US

IV. Provider business mailing address

4645 LA GUARDIA DRIVE
BERKELEY MO
63134
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-1600
  • Fax: 314-994-0179
Mailing address:
  • Phone: 314-994-1600
  • Fax: 314-994-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LORI A BURCH
Title or Position: CFO
Credential:
Phone: 636-779-2251