Organization Name: | INDEPENDENCE CENTER |
NPI Number: | 1174669006 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MIKE KELLER (EXECTUVE DIRECTOR) |
Mailing Address: | 2443 Prouhet Ave Saint Louis |
State: | MO US |
Postal Code: | 631141946 |
Phone Number: | 3148907100 |
Fax Number: | 3148907133 |
NPI Enumeration Date: | 01/29/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 030777 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |