Provider Demographics
NPI:1275759144
Name:JEWISH COMMUNITY CENTER
Entity Type:Organization
Organization Name:JEWISH COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTELS
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:314-442-3182
Mailing Address - Street 1:2 MILLSTONE CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5776
Mailing Address - Country:US
Mailing Address - Phone:314-432-5700
Mailing Address - Fax:314-872-7189
Practice Address - Street 1:2 MILLSTONE CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5776
Practice Address - Country:US
Practice Address - Phone:314-432-5700
Practice Address - Fax:314-872-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO584261QA0600X
MO1036320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities