Organization
MERS/MISSOURI GOODWILL INDUSTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEWIS C CHARTOCK PH.D. (CHIEF EXECUTIVE OFFICER)
(314) 982-8888
Entity
Organization
Contact information
Practice address
1727 LOCUST ST, SAINT LOUIS, MO 63103-1703
(314) 982-0000
(314) 982-1588
Mailing address
1727 LOCUST ST, SAINT LOUIS, MO 63103-1703
(314) 982-0000
(314) 982-1588
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/30/2012
Last updated
03/30/2012
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