Provider Demographics
NPI:1003179201
Name:MENZIES INSTITUTE OF RECOVERY FROM ADDICTION, LLC
Entity Type:Organization
Organization Name:MENZIES INSTITUTE OF RECOVERY FROM ADDICTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZIES
Authorized Official - Suffix:
Authorized Official - Credentials:M PHARM
Authorized Official - Phone:314-645-6840
Mailing Address - Street 1:6651 CHIPPEWA ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2538
Mailing Address - Country:US
Mailing Address - Phone:314-645-3840
Mailing Address - Fax:314-645-6847
Practice Address - Street 1:6651 CHIPPEWA ST
Practice Address - Street 2:SUITE 224
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2538
Practice Address - Country:US
Practice Address - Phone:314-645-3840
Practice Address - Fax:314-645-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility