Provider Demographics
NPI:1043539521
Name:CHESTERFIELD TREATMENT CENTER
Entity Type:Organization
Organization Name:CHESTERFIELD TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRANCK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-336-2570
Mailing Address - Street 1:14825 N OUTER 40 RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:314-336-2570
Mailing Address - Fax:314-336-2571
Practice Address - Street 1:14825 N OUTER 40 RD
Practice Address - Street 2:SUITE 365
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2570
Practice Address - Fax:314-336-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 261QM1300X, 261QR0400X
MO2009025407261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation