Provider Demographics
NPI:1073632949
Name:UNITED CEREBRAL PALSY ASSOCIATION OF GREATER ST. LOUIS
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY ASSOCIATION OF GREATER ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORKOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-994-1600
Mailing Address - Street 1:8645 OLD BONHOMME RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3901
Mailing Address - Country:US
Mailing Address - Phone:314-994-1600
Mailing Address - Fax:314-994-0179
Practice Address - Street 1:8645 OLD BONHOMME RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3901
Practice Address - Country:US
Practice Address - Phone:314-994-1600
Practice Address - Fax:314-994-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care