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General NPI Number Information
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NPI Number | 1508056425
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Entity Type | Organization
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Legal Business Name | MIZPAH ASSISTED LIVING SERVICES
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 11325 SAINT CHARLES ROCK RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2722
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Country | US
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Telephone | 314-209-1177
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Fax | 314-738-0777
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Provider Business Mailing Address
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Address Line | 11325 SAINT CHARLES ROCK RD
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City | BRIDGETON
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State | MO
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Zip | 63044-2722
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Country | US
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Telephone | 314-209-1177
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Fax | 314-738-0777
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JULIE KLEIN
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Credential |
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Telephone | 314-209-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 032466
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License Number State | MO
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