1629253380 NPI number — ST. CHARLES COUNTY ASSOCIATION FOR RETARDED CITIZENS

Table of content: (NPI 1629253380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629253380 NPI number — ST. CHARLES COUNTY ASSOCIATION FOR RETARDED CITIZENS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CHARLES COUNTY ASSOCIATION FOR RETARDED CITIZENS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY SUPPORT SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629253380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 SHERIFF DIERKER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63366-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-946-2546
Provider Business Mailing Address Fax Number:
636-272-0258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 SHERIFF DIERKER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63366-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-946-2546
Provider Business Practice Location Address Fax Number:
636-272-0258
Provider Enumeration Date:
12/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
636-946-2546

Provider Taxonomy Codes

  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)