Provider Demographics
NPI:1093082117
Name:BCI BOONE CENTER LLC
Entity Type:Organization
Organization Name:BCI BOONE CENTER LLC
Other - Org Name:BCI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-978-4300
Mailing Address - Street 1:200 TRADE CENTER DR W
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1190
Mailing Address - Country:US
Mailing Address - Phone:636-978-4300
Mailing Address - Fax:636-978-4343
Practice Address - Street 1:200 TRADE CENTER DR W
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1190
Practice Address - Country:US
Practice Address - Phone:636-978-4300
Practice Address - Fax:636-978-4343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONE CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities