MEDICARE: THE SALVATION ARMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	1825	MO
2	251S00000X	Community/Behavioral Health Agency	1825	MO

General Provider Information

NPI Number	:	1386015055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SALVATION ARMY

Provider Business Mailing Address
First Line	:	1130 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3147
Country	:	US
Telephone Number	:	314-646-3000
Fax Number	:	314-646-3182

Provider Business Practice Location Address
First Line	:	3010 WASHINGTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1335
Country	:	US
Telephone Number	:	314-652-3310
Fax Number	:	314-286-3230

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	MR. BRAMWELL HIGGINS
Credential	:
Telephone Number	:	847-294-2154

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/07/2015

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Directions to “THE SALVATION ARMY ” Practice Location

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