Healthcare Provider Details

I. General information

NPI: 1285752378
Provider Name (Legal Business Name): THE CHILDREN'S HOME SOCIETY OF MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 LITZSINGER RD
SAINT LOUIS MO
63144-2113
US

IV. Provider business mailing address

9445 LITZSINGER RD
SAINT LOUIS MO
63144-2113
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-2350
  • Fax: 314-968-4239
Mailing address:
  • Phone: 314-968-2350
  • Fax: 314-968-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. LARRY DUKE
Title or Position: DIRECTOR OF BUSINESS & FINANCE
Credential:
Phone: 314-968-2350