Provider Demographics
NPI:1336508845
Name:SUMMIT BHC SAINT LOUIS, LLC
Entity Type:Organization
Organization Name:SUMMIT BHC SAINT LOUIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-716-4924
Mailing Address - Street 1:1391 SMIZER MILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7306
Mailing Address - Country:US
Mailing Address - Phone:615-721-5230
Mailing Address - Fax:888-418-7712
Practice Address - Street 1:333 S KIRKWOOD RD STE 303
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6161
Practice Address - Country:US
Practice Address - Phone:888-979-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT BHC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility