Healthcare Provider Details

I. General information

NPI: 1376667469
Provider Name (Legal Business Name): FOCUS ON RESIDENTIAL SERVICES DBA LAFAYETTE HABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 HENRIETTA ST
SAINT LOUIS MO
63104-2007
US

IV. Provider business mailing address

2701 HENRIETTA ST
SAINT LOUIS MO
63104-2007
US

V. Phone/Fax

Practice location:
  • Phone: 314-771-4777
  • Fax: 314-771-0697
Mailing address:
  • Phone: 314-771-4777
  • Fax: 314-771-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number24529238
License Number StateMO

VIII. Authorized Official

Name: MS. BARBARA TOWNSEND
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 314-771-4777