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General NPI Number Information
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NPI Number | 1164235362
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Entity Type | Organization
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Legal Business Name | INTERFAITH RESIDENCE
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1101 N JEFFERSON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63106-2222
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Country | US
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Telephone | 314-535-1919
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Fax | 314-535-0909
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Provider Business Mailing Address
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Address Line | 1101 N JEFFERSON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63106-2222
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Country | US
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Telephone | 314-535-1919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | OPAL JONES
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Credential |
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Telephone | 314-535-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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