Healthcare Provider Details

I. General information

NPI: 1134803075
Provider Name (Legal Business Name): BTRSTL LADUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10324 LADUE RD
SAINT LOUIS MO
63141-8401
US

IV. Provider business mailing address

10324 LADUE RD
SAINT LOUIS MO
63141-8401
US

V. Phone/Fax

Practice location:
  • Phone: 314-949-2080
  • Fax:
Mailing address:
  • Phone: 314-949-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DION BUFFALOW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-819-9727