Healthcare Provider Details

I. General information

NPI: 1679578413
Provider Name (Legal Business Name): CHILD CENTER OF OUR LADY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-4628
US

IV. Provider business mailing address

7900 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-4628
US

V. Phone/Fax

Practice location:
  • Phone: 314-383-0200
  • Fax: 314-383-6334
Mailing address:
  • Phone: 314-383-0200
  • Fax: 314-383-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM BAUSCH
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 314-383-0200