MEDICARE: CAMPBELL MONTESSORI SCHOOL

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1518311109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELL MONTESSORI SCHOOL

Provider Business Mailing Address
First Line	:	3880 SHADY SPRINGS LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4126
Country	:	US
Telephone Number	:	636-477-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3880 SHADY SPRINGS LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4126
Country	:	US
Telephone Number	:	636-477-8200
Fax Number	:

Authorized Official
Title or Position	:	BOARD CHAIR
Name	:	MR. PAUL B. CAMPBELL
Credential	:
Telephone Number	:	636-477-8200

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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