Healthcare Provider Details

I. General information

NPI: 1366500555
Provider Name (Legal Business Name): CARDINAL RITTER SENIOR SERVICES ADULT HEALTH DAY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7663 WATSON RD
SAINT LOUIS MO
63119-5038
US

IV. Provider business mailing address

7601 WATSON RD
SAINT LOUIS MO
63119-5001
US

V. Phone/Fax

Practice location:
  • Phone: 314-962-7501
  • Fax: 314-962-7140
Mailing address:
  • Phone: 314-962-7501
  • Fax: 314-962-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number655
License Number StateMO

VIII. Authorized Official

Name: MR. RON MANTIA
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-961-8000