Organization
PROVIDENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIN BULIN MSW (DIRECTOR OF COUNSELING DIVISION)
(314) 371-6500
Entity
Organization
Contact information
Practice address
3675 W OUTER RD, 203, ARNOLD, MO 63010-5232
(314) 898-0102
(636) 296-3249
Mailing address
3675 W OUTER RD, 203, ARNOLD, MO 63010-5232
(314) 898-0102
(636) 296-3249
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
002589
MO
305R00000X
Preferred Provider Organization
Primary
SW002589
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
496768326
—
MO
Enumeration date
12/04/2006
Last updated
09/11/2025
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