MEDICARE: CENTER STAGE INC.

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	110141	MO

General Provider Information

NPI Number	:	1720259534
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	:	314-533-6601

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	:	DIRECTOR
Name	:	MRS. ALFREDA SMITH
Credential	:	RN
Telephone Number	:	314-533-6600

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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