Organization · Type 2 NPI

State of Missouri

Intellectual and/or Developmental Disabilities Residential Treatment Facility · St. Louis, MO

NPI number 1326372301 Active

Practice location

11 Brady Cir, 2
St. Louis, MO 63114-1110

Fax (314) 340-6746

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary	320600000X	E650S000001 (MO)

Intellectual and/or Developmental Disabilities Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

2 other providers at this address

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NPI record

NPI: 1326372301
Entity type: Organization (Type 2)
Issued: Sep 24, 2009
Last updated: Oct 27, 2020
Status: Active

Other names

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Slddtc - 2 Brady Circle · doing business as
Slddtc - 2 Brady Circle · doing business as

Authorized official

Molly Jane Boeckmann
Director of Administrative Services
(573) 751-4055

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1326372301

State of Missouri's National Provider Identifier is 1326372301, issued on Sep 24, 2009. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in St. Louis, MO. The record was last updated on Oct 27, 2020.