MEDICARE: FATHER DUNNE'S NEWSBOYS HOME AND PROTECTORATE

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1508868852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATHER DUNNE'S NEWSBOYS HOME AND PROTECTORATE

Provider Business Mailing Address
First Line	:	853 DUNN RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8203
Country	:	US
Telephone Number	:	314-837-0513
Fax Number	:	314-837-0883

Provider Business Practice Location Address
First Line	:	853 DUNN RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8203
Country	:	US
Telephone Number	:	314-837-0513
Fax Number	:	314-837-0883

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KELLY PIPKINS-BURT
Credential	:	M.ED, LPC
Telephone Number	:	314-837-0513

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2020

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