MEDICARE: ST. LOUIS PROJECT CLUB

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1649723081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS PROJECT CLUB

Provider Business Mailing Address
First Line	:	1428 CHOUTEAU AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-3105
Country	:	US
Telephone Number	:	314-200-5707
Fax Number	:	314-499-4358

Provider Business Practice Location Address
First Line	:	3662 S BROADWAY S
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-4045
Country	:	US
Telephone Number	:	314-200-5707
Fax Number	:	314-499-4358

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARY CURLEE
Credential	:
Telephone Number	:	314-730-0070

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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Directions to “ST. LOUIS PROJECT CLUB ” Practice Location

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