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General NPI Number Information
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NPI Number | 1609918903
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Entity Type | Organization
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Legal Business Name | EASTER SEALS MISSOURI, INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13975 MANCHESTER RD
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City | BALLWIN
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State | MO
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Zip | 63011-4500
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Country | US
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Telephone | 636-779-2250
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Fax | 636-779-2270
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Provider Business Mailing Address
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Address Line | 13975 MANCHESTER RD
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City | BALLWIN
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State | MO
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Zip | 63011-4500
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Country | US
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Telephone | 636-779-2250
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Fax | 636-779-2270
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CRAIG BYRD
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Credential |
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Telephone | 636-779-2250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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