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General NPI Number Information
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NPI Number | 1366770604
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Entity Type | Organization
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Legal Business Name | CRIDER HEALTH CENTER,INC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 1032 CROSSWINDS CT
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City | WENTZVILLE
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State | MO
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Zip | 63385-4836
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Country | US
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Telephone | 636-332-6000
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Fax | 363-332-3045
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Provider Business Mailing Address
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Address Line | 1032 CROSSWINDS CT
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City | WENTZVILLE
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State | MO
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Zip | 63385-4836
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Country | US
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Telephone | 636-332-6000
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Fax | 363-332-3045
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Authorized Official
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Title or Position | ASSOCIATE CEO, COO
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Name | LAURA HEEBNER
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Credential |
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Telephone | 636-332-8306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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