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General NPI Number Information
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NPI Number | 1083732929
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Entity Type | Organization
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Legal Business Name | WILBAR BOARDING HOME INC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 4337 MARYLAND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2703
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Country | US
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Telephone | 314-535-2141
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Fax | 314-535-3717
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Provider Business Mailing Address
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Address Line | 4337 MARYLAND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2703
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Country | US
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Telephone | 314-535-2141
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Fax | 314-535-3717
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MRS. BARBARA BAKER
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Credential | R.N.
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Telephone | 314-535-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 032570
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License Number State | MO
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