Healthcare Provider Details

I. General information

NPI: 1437608312
Provider Name (Legal Business Name): PREFERRED FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 OLD S. RIVER ROAD
ST.CHARLES MO
63303
US

IV. Provider business mailing address

118 N 2ND ST
SAINT CHARLES MO
63301-2832
US

V. Phone/Fax

Practice location:
  • Phone: 844-224-2400
  • Fax: 636-959-5168
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILYN NOLAN
Title or Position: CEO
Credential:
Phone: 417-869-8911