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Organization
STATE OF MISSOURI
Active
Organization
STATE OF MISSOURI
Active
Other names
SLDDTC - 2 Brady Circle
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY JANE BOECKMANN (DIRECTOR OF ADMINISTRATIVE SERVICES)
(573) 751-4055
Entity
Organization
Contact information
Practice address
11 BRADY CIR, 2, SAINT LOUIS, MO 63114-1110
(314) 340-6701
(314) 340-6746
Mailing address
11 BRADY CIR, 2, SAINT LOUIS, MO 63114-1110
(314) 340-6701
(314) 340-6746
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
E650S000001
MO
Other
Enumeration date
09/24/2009
Last updated
10/27/2020
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