Healthcare Provider Details

I. General information

NPI: 1649339771
Provider Name (Legal Business Name): RESIDENCIAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 EICHELBERGER
ST LOUIS MO
63109
US

IV. Provider business mailing address

7601 WATSON ROAD
ST LOUIS MO
63119
US

V. Phone/Fax

Practice location:
  • Phone: 314-752-1901
  • Fax: 314-752-0572
Mailing address:
  • Phone: 314-961-8000
  • Fax: 314-961-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number032709
License Number StateMO

VIII. Authorized Official

Name: MS. JACQUELINE J BONNESS
Title or Position: CFO
Credential: CPA
Phone: 314-361-8000