Healthcare Provider Details

I. General information

NPI: 1649503772
Provider Name (Legal Business Name): SAFE KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CREEKSIDE OFFICE DR
WENTZVILLE MO
63385-3290
US

IV. Provider business mailing address

7 COUNTRY ROAD
FORISTELL MO
63348-0186
US

V. Phone/Fax

Practice location:
  • Phone: 636-357-0136
  • Fax: 866-272-2483
Mailing address:
  • Phone: 636-357-0136
  • Fax: 866-272-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number2007036957
License Number StateMO

VIII. Authorized Official

Name: URSULA W MARSH
Title or Position: OWNER
Credential: PH.D.
Phone: 636-357-0136