Healthcare Provider Details

I. General information

NPI: 1194846220
Provider Name (Legal Business Name): ST. LOUIS ARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 LACKLAND HILL PKWY STE 200
SAINT LOUIS MO
63146-3507
US

IV. Provider business mailing address

1816 LACKLAND HILL PKWY STE 200
SAINT LOUIS MO
63146-3507
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0778
  • Fax:
Mailing address:
  • Phone: 314-569-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: KATHLEEN TISONE
Title or Position: VICE PRESIDENT OPERATIONS CFO
Credential: CFO
Phone: 314-817-2207