Healthcare Provider Details

I. General information

NPI: 1235202870
Provider Name (Legal Business Name): RESIDENTIAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N NEWSTEAD
ST LOUIS MO
63108
US

IV. Provider business mailing address

7601 WATSON RD
SAINT LOUIS MO
63119-5001
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-9525
  • Fax: 314-652-8879
Mailing address:
  • Phone: 314-961-8000
  • Fax: 314-962-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number032905
License Number StateMO

VIII. Authorized Official

Name: KANYEKA CEDELL GARNER
Title or Position: BILLING ACCT REP
Credential:
Phone: 314-918-2263