MEDICARE: ST. LOUIS ARC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	103091	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962688218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS ARC

Provider Business Mailing Address
First Line	:	1816 LACKLAND HILL PKWY
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 LACKLAND HILL PKWY
Second Line	:	VILLA 2
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3507
Country	:	US
Telephone Number	:	314-569-2211
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS/CFO
Name	:	MRS. KATHLEEN ANNE TISONE
Credential	:
Telephone Number	:	314-569-2211

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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1194846220 — ST. LOUIS ARC
Practice Location Address:

1816 LACKLAND HILL PKWY STE 200
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1700062064 — ST. LOUIS ARC
Practice Location Address:

1816 LACKLAND HILL PKWY , 438 GLAN TAI
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1821274184 — ST. LOUIS ARC
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1467638726 — ST. LOUIS ARC
Practice Location Address:

1816 LACKLAND HILL PKWY , 10857 PICCADILLY
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Practice Fax:

Directions to “ST. LOUIS ARC ” Practice Location

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