Healthcare Provider Details

I. General information

NPI: 1003179201
Provider Name (Legal Business Name): MENZIES INSTITUTE OF RECOVERY FROM ADDICTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 CHIPPEWA ST SUITE 224
SAINT LOUIS MO
63109-2538
US

IV. Provider business mailing address

6651 CHIPPEWA ST SUITE 224
SAINT LOUIS MO
63109-2538
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-3840
  • Fax: 314-645-6847
Mailing address:
  • Phone: 314-645-3840
  • Fax: 314-645-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PERCY MENZIES
Title or Position: PRESIDENT
Credential: M. PHARM.
Phone: 314-645-6840