Healthcare Provider Details

I. General information

NPI: 1225740293
Provider Name (Legal Business Name): CHILDREN'S PERMANENCY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 OFFICE CENTER AVE
SAPPINGTON MO
63128-1258
US

IV. Provider business mailing address

10024 OFFICE CENTER AVE
SAPPINGTON MO
63128-1258
US

V. Phone/Fax

Practice location:
  • Phone: 314-733-5759
  • Fax:
Mailing address:
  • Phone: 314-733-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANN RENE HERZ
Title or Position: ASSOCIATE DIRECTOR OF Q&C
Credential:
Phone: 636-236-5887