Healthcare Provider Details

I. General information

NPI: 1750799003
Provider Name (Legal Business Name): CHILDGARDEN CHILD DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 LACLEDE AVE
SAINT LOUIS MO
63108-2813
US

IV. Provider business mailing address

4150 LACLEDE AVE
SAINT LOUIS MO
63108-2813
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-8148
  • Fax:
Mailing address:
  • Phone: 314-531-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2014023327
License Number StateMO

VIII. Authorized Official

Name: KRISTIN HATTY
Title or Position: CENTER DIRECTOR
Credential:
Phone: 314-531-8148