1326219866 NPI number — THE BOYHOOD INITIATIVE OF MISSOURI

Table of content: THALIA CHRISTINA FORD ARNP (NPI 1134614977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326219866 NPI number — THE BOYHOOD INITIATIVE OF MISSOURI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BOYHOOD INITIATIVE OF MISSOURI
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:
1326219866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8434 PAGE 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:
63130-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-882-6830
Provider Business Mailing Address Fax Number:
618-566-8186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8434 PAGE 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:
63130-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-882-6830
Provider Business Practice Location Address Fax Number:
314-427-2303
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
HUEY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
314-882-6840

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2002027247 , 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)





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