Organization
INDEPENDENCE CENTER
Active
Other names
Jane Howell Stupp Apartments
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA HOLMES (EXECTUVE DIRECTOR)
(314) 880-5415
Entity
Organization
Contact information
Practice address
2443 PROUHET AVE, SAINT LOUIS, MO 63114-1946
(314) 890-7100
(314) 890-7133
Mailing address
8675 OLIVE BLVD, SAINT LOUIS, MO 63132-2503
(314) 373-5187
(314) 367-5626
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
030777
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267727600
—
MO
Enumeration date
01/29/2007
Last updated
06/27/2022
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