Provider Demographics
NPI:1083732929
Name:WILBAR BOARDING HOME INC.
Entity Type:Organization
Organization Name:WILBAR BOARDING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-535-2141
Mailing Address - Street 1:4337 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2703
Mailing Address - Country:US
Mailing Address - Phone:314-535-2141
Mailing Address - Fax:314-535-3717
Practice Address - Street 1:4337 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2703
Practice Address - Country:US
Practice Address - Phone:314-535-2141
Practice Address - Fax:314-535-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0325703104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266937200Medicaid