Provider Demographics
NPI:1235202870
Name:RESIDENTIAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:RESIDENTIAL SERVICES CORPORATION
Other - Org Name:ST. ELIZABETH HALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ACCT REP
Authorized Official - Prefix:
Authorized Official - First Name:KANYEKA
Authorized Official - Middle Name:CEDELL
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-918-2263
Mailing Address - Street 1:7601 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5001
Mailing Address - Country:US
Mailing Address - Phone:314-961-8000
Mailing Address - Fax:314-962-4159
Practice Address - Street 1:325 N NEWSTEAD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-652-9525
Practice Address - Fax:314-652-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032905310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266741404Medicaid