Organization
INDEPENDENCE CENTER
Active
Other names
Newstead Place
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA HOLMES (EXECUTIVE DIRECTOR)
(314) 880-5415
Entity
Organization
Contact information
Practice address
19 N NEWSTEAD AVE, SAINT LOUIS, MO 63108-2260
(314) 286-4510
(314) 286-4565
Mailing address
4245 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 880-5415
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
033539
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267827400
—
MO
Enumeration date
01/29/2007
Last updated
06/27/2022
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