MEDICARE: CENTER STAGE INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1598366890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER STAGE INC.

Provider Business Mailing Address
First Line	:	3923 WASHINGTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3507
Country	:	US
Telephone Number	:	314-533-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3923 WASHINGTON BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3507
Country	:	US
Telephone Number	:	314-533-6600
Fax Number	:	314-533-6601

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ALFREDA SMITH
Credential	:
Telephone Number	:	314-533-6600

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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