Organization Name: | YOUNG MENS CHRISTIAN ASSOCIATION OF GREATER ST LOUIS |
NPI Number: | 1609218593 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBRA REDMOND (SENIOR PROGRAM DIRECTOR) |
Mailing Address: | 1528 Locust St Saint Louis |
State: | MO US |
Postal Code: | 631031816 |
Phone Number: | 3144361177 |
Fax Number: | 3144361901 |
NPI Enumeration Date: | 07/22/2013 |
NPI Last Update Date: | 08/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | EL1-0043-0313 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |