Healthcare Provider Details

I. General information

NPI: 1962525659
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY ASSOCIATION OF GREATER ST. LOUIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 OLD BONHOMME RD
SAINT LOUIS MO
63132-3901
US

IV. Provider business mailing address

8645 OLD BONHOMME RD
SAINT LOUIS MO
63132-3901
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-1600
  • Fax: 314-994-0179
Mailing address:
  • Phone: 314-994-1600
  • Fax: 314-994-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICHARD FORKOSH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-994-1600