MEDICARE: PRESBYTERIAN CHILDREN'S SERVICES

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

General Provider Information

NPI Number	:	1982879284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN CHILDREN'S SERVICES

Provider Business Mailing Address
First Line	:	716 N AULT ST
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-2614
Country	:	US
Telephone Number	:	660-263-7044
Fax Number	:	660-263-8857

Provider Business Practice Location Address
First Line	:	1353 N WARSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1807
Country	:	US
Telephone Number	:	314-989-9727
Fax Number	:

Authorized Official
Title or Position	:	SITE DIRECTOR
Name	:	MELISSA SMYSER
Credential	:
Telephone Number	:	660-263-7044

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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