Provider Demographics
NPI:1275854788
Name:COMPREHENSIVE INDEPENDENT GOALS INC ST LOUIS
Entity Type:Organization
Organization Name:COMPREHENSIVE INDEPENDENT GOALS INC ST LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-926-5192
Mailing Address - Street 1:PO BOX 66037
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6037
Mailing Address - Country:US
Mailing Address - Phone:866-926-5192
Mailing Address - Fax:866-926-5191
Practice Address - Street 1:40 N KINGSHIGHWAY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1370
Practice Address - Country:US
Practice Address - Phone:866-926-5192
Practice Address - Fax:866-926-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1157384Medicaid
LA1642649Medicaid
LA1173835Medicaid
LA1157392Medicaid