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Organization

ST. LOUIS ARC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KATHLEEN ANNE TISONE (VP OPERATIONS/CFO)
(314) 817-2207
Entity
Organization

Contact information

Practice address
714 CARRIAGE LN, HAZELWOOD, MO 63042-3452
(314) 817-2207
Mailing address
1177 N WARSON RD, SAINT LOUIS, MO 63132-1810

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
103091
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
852998301
MO
Enumeration date
01/17/2008
Last updated
06/12/2012
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