Organization
N/A
Active
Other names
Gloria Patrick
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLORIA JEAN PATRICK (HOME AID)
(314) 401-1466
Entity
Organization
Contact information
Practice address
1318 PENNSYLVANIA AVE, SAINT LOUIS, MO 63133-1036
(314) 401-1466
Mailing address
1318 PENNSYLVANIA AVE, PAGEDALE, MO 63133-1036
(314) 401-1466
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
07397218
MO
320700000X
Physical Disabilities Residential Treatment Facility
07397218
MO
323P00000X
Psychiatric Residential Treatment Facility
Primary
07397218
MO
Other
Enumeration date
04/11/2011
Last updated
04/11/2011
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