Healthcare Provider Details

I. General information

NPI: 1770759771
Provider Name (Legal Business Name): REYNOLD'S INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 CORNELL AVE
SAINT LOUIS MO
63130
US

IV. Provider business mailing address

7460 CORNELL
SAINT LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-8111
  • Fax:
Mailing address:
  • Phone: 314-727-8111
  • 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 State

VIII. Authorized Official

Name: MISS DENAY M REYNOLDS
Title or Position: EXECUTIVE DIRECTOR
Credential: MASTER OF EDUCATION
Phone: 618-531-9003