Provider Demographics
NPI:1336316777
Name:CITY OF ST. LOUIS DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:CITY OF ST. LOUIS DEPARTMENT OF HEALTH
Other - Org Name:LEAD SAFE ST. LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:MELTON
Authorized Official - Last Name:OTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:314-612-5056
Mailing Address - Street 1:634 N GRAND BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1002
Mailing Address - Country:US
Mailing Address - Phone:314-612-5056
Mailing Address - Fax:314-612-5458
Practice Address - Street 1:634 N GRAND BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1002
Practice Address - Country:US
Practice Address - Phone:314-612-5056
Practice Address - Fax:314-612-5458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF ST. LOUIS DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO510400708251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare