Organization
COMMUNITY SUPPORTIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISAAC ONYEMA (DIRECTOR)
(314) 454-1219
Entity
Organization
Contact information
Practice address
3520 HAMPTON AVE, ST LOUIS, MO 63139-1918
(314) 454-1219
(314) 454-1382
Mailing address
3520 HAMPTON AVE, SAINT LOUIS, MO 63139-1918
(314) 454-1219
(314) 454-1382
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/01/2011
Last updated
04/01/2011
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