Organization
FULL POTENTIAL RESIDENTIAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEMETRA EVON ROBERTS LIC. SOCIAL WORKER (ADMINISTRATOR)
(314) 839-9157
Entity
Organization
Contact information
Practice address
8208 PAGE AVE, SAINT LOUIS, MO 63130-1115
(314) 839-9157
(314) 839-9157
Mailing address
2335 INDIANCUP DR, FLORISSANT, MO 63033-1736
(314) 839-9157
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2006031224
MO
Other
Enumeration date
08/28/2008
Last updated
08/28/2008
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