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General NPI Number Information
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NPI Number | 1194846220
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Entity Type | Organization
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Legal Business Name | ST. LOUIS ARC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 1816 LACKLAND HILL PKWY STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3507
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Country | US
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Telephone | 314-569-0778
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 LACKLAND HILL PKWY STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3507
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Country | US
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Telephone | 314-569-0778
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OPERATIONS CFO
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Name | KATHLEEN TISONE
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Credential | CFO
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Telephone | 314-817-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | MO
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