Provider Demographics
NPI:1255488623
Name:EPWORTH CHILDREN & FAMILY SERVICES
Entity Type:Organization
Organization Name:EPWORTH CHILDREN & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-918-3352
Mailing Address - Street 1:110 N ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2418
Mailing Address - Country:US
Mailing Address - Phone:314-961-5718
Mailing Address - Fax:314-961-3503
Practice Address - Street 1:110 N ELM AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2418
Practice Address - Country:US
Practice Address - Phone:314-961-5718
Practice Address - Fax:314-961-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
MO000045043322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507596104Medicaid