Organization
ST LOUIS ARC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN TISONE (VP OF OPERATIONS, CFO)
(314) 569-2211
Entity
Organization
Contact information
Practice address
1228 DAUTEL, ST LOUIS, MO 63146
(314) 569-2211
Mailing address
1816 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3507
(314) 569-2211
(314) 569-0778
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856274709
—
MO
Enumeration date
03/07/2008
Last updated
03/07/2008
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