Organization
MAGDALA FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MANGOGNA (PRESIDENT/CEO)
(314) 652-6004
Entity
Organization
Contact information
Practice address
3148 S KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63139-1118
(314) 571-9950
Mailing address
4158 LINDELL BLVD, SAINT LOUIS, MO 63108-2914
(314) 652-6004
(314) 652-8351
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
2452-10039
MO
315P00000X
Intellectual Disabilities Intermediate Care Facility
2452-10040
MO
315P00000X
Intellectual Disabilities Intermediate Care Facility
2452-10041
MO
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2452-10042
MO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2452, 1460-7235
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112182605
—
MO
05
—
112182704
—
MO
05
—
112364401
—
MO
05
—
112364500
—
MO
05
—
852098805
—
MO
Enumeration date
11/20/2006
Last updated
07/11/2024
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