Provider Demographics
NPI:1275877805
Name:RIDE ON ST LOUIS, INC.
Entity Type:Organization
Organization Name:RIDE ON ST LOUIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-464-3408
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:KIMMSWICK
Mailing Address - State:MO
Mailing Address - Zip Code:63053-0094
Mailing Address - Country:US
Mailing Address - Phone:636-464-3408
Mailing Address - Fax:
Practice Address - Street 1:6008 WINDSOR HARBOR LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052
Practice Address - Country:US
Practice Address - Phone:636-464-3408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01694320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities