Organization
INDEPENDENCE CENTER
Active
Organization
INDEPENDENCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA HOLMES (EXECUTIVE DIRECTOR)
(314) 880-5415
Entity
Organization
Contact information
Practice address
4245 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 880-5415
Mailing address
8675 OLIVE BLVD, SAINT LOUIS, MO 63132-2503
(314) 373-5187
(314) 367-5626
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876173501
—
MO
Enumeration date
03/13/2007
Last updated
06/27/2022
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