Organization
FULL POTENTIAL RESIDENTIAL SERVICES, LLC
Active
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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