Healthcare Provider Details

I. General information

NPI: 1285755579
Provider Name (Legal Business Name): COUNCIL FOR EXTENDED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5257 SHAW AVE SUITE 305
SAINT LOUIS MO
63110-3029
US

IV. Provider business mailing address

5257 SHAW AVE SUITE 305
SAINT LOUIS MO
63110-3029
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-4950
  • Fax: 314-771-8880
Mailing address:
  • Phone: 314-781-4950
  • Fax: 314-771-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number12483150
License Number StateMO

VIII. Authorized Official

Name: VICTORIA K PRESNELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-781-4950