Organization
COMMUNITY RESIDENTIAL SUPPORTIVE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA GILLESPIE (DIRECT SUPPORT PROFESSIONAL)
(314) 869-1977
Entity
Organization
Contact information
Practice address
1026 VILLA ST.CYR, SAINT LOUIS, MO 63137
(314) 869-1977
(314) 869-1977
Mailing address
1026 VILLA ST.CYR, SAINT LOUIS, MO 63137
(314) 869-1977
(314) 869-1977
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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