Organization
ST. LOUIS ARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN ANNE TISONE (VP OPERATIONS/CFO)
(314) 569-2211
Entity
Organization
Contact information
Practice address
1816 LACKLAND HILL PKWY, 3642 WILMINGTON, SAINT LOUIS, MO 63146-3507
(314) 569-2211
(314) 569-0778
Mailing address
1816 LACKLAND HILL PKWY, SUITE 200, SAINT LOUIS, MO 63146-3507
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
—
856161609
—
MO
Enumeration date
01/17/2008
Last updated
01/17/2008
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