1083732929 NPI number — WILBAR BOARDING HOME INC.

Table of content: (NPI 1083732929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083732929 NPI number — WILBAR BOARDING HOME INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILBAR BOARDING HOME INC.
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:
Provider Other Organization Name Type Code:
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:
1083732929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4337 MARYLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63108-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-535-2141
Provider Business Mailing Address Fax Number:
314-535-3717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4337 MARYLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63108-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-535-2141
Provider Business Practice Location Address Fax Number:
314-535-3717
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
314-535-2141

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  032570 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 266937200 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com