=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841318193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLWAYS KARE RESIDENTIAL FACILITY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 11/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5076 WATERMAN BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-367-9516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 BEVERLY PL
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63112-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-367-3743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONALD TREVOR CROSS SR.
-----------------------------------------------------
Credential | PSYCHOLOGIST
-----------------------------------------------------
Telephone | 314-367-3743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | 032341
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------