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General NPI Number Information
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NPI Number | 1285755579
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Entity Type | Organization
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Legal Business Name | COUNCIL FOR EXTENDED CARE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5257 SHAW AVE SUITE 305
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3029
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Country | US
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Telephone | 314-781-4950
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Fax | 314-771-8880
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Provider Business Mailing Address
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Address Line | 5257 SHAW AVE SUITE 305
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3029
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Country | US
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Telephone | 314-781-4950
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Fax | 314-771-8880
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VICTORIA K PRESNELL
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Credential |
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Telephone | 314-781-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 12483150
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License Number State | MO
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