Organization
JUDEVINE, INC.
Active
Other names
Judevine Center for Autism
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA BLACKWELL MA, BCBA (PRESIDENT/DIRECTOR)
(800) 780-6545
Entity
Organization
Contact information
Practice address
1810 CRAIG RD STE 109, SAINT LOUIS, MO 63146-4758
(800) 780-6545
(888) 507-4453
Mailing address
1810 CRAIG RD STE 109, SAINT LOUIS, MO 63146-4758
(800) 780-6545
(888) 507-4453
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
ER019910064
MO
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
ER019910064
MO
Other
Enumeration date
09/24/2009
Last updated
01/07/2015
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