Provider Demographics
NPI:1093836389
Name:COUNCIL FOR EXTENDED CARE OF MENTALLY RETARDED CITIZENS
Entity Type:Organization
Organization Name:COUNCIL FOR EXTENDED CARE OF MENTALLY RETARDED CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRESNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-781-4950
Mailing Address - Street 1:5257 SHAW AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3029
Mailing Address - Country:US
Mailing Address - Phone:314-781-4950
Mailing Address - Fax:314-771-8880
Practice Address - Street 1:5257 SHAW AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3029
Practice Address - Country:US
Practice Address - Phone:314-781-4950
Practice Address - Fax:314-771-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12483150320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities