Healthcare Provider Details

I. General information

NPI: 1730225590
Provider Name (Legal Business Name): GOOD SHEPHERD SCHOOL FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 TIMBER RUN DR
SAINT LOUIS MO
63146-4482
US

IV. Provider business mailing address

1170 TIMBER RUN DR
SAINT LOUIS MO
63146-4482
US

V. Phone/Fax

Practice location:
  • Phone: 314-469-0606
  • Fax: 314-469-3294
Mailing address:
  • Phone: 314-469-0606
  • Fax: 314-469-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH A. ROSE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.W. LCSW
Phone: 314-469-0606