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Organization
RIDE ON ST LOUIS, INC.
Active
Organization
RIDE ON ST LOUIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARITA A WASSMAN (PROGRAM DIRECTOR)
(636) 464-3408
Entity
Organization
Contact information
Practice address
6008 WINDSOR HARBOR LN, IMPERIAL, MO 63052
(636) 464-3408
Mailing address
PO BOX 94, KIMMSWICK, MO 63053-0094
(636) 464-3408
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
01694
MO
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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