Provider Demographics
NPI:1376082529
Name:THE OUTREACH CENTER OF CHRIST THE SAVIOR
Entity Type:Organization
Organization Name:THE OUTREACH CENTER OF CHRIST THE SAVIOR
Other - Org Name:HAPPY SPIRIT DAY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MINISTER/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR/MINISTER
Authorized Official - Phone:314-371-9999
Mailing Address - Street 1:3904 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3502
Mailing Address - Country:US
Mailing Address - Phone:314-371-9999
Mailing Address - Fax:314-371-0466
Practice Address - Street 1:3904 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3502
Practice Address - Country:US
Practice Address - Phone:314-371-9999
Practice Address - Fax:314-371-0466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAPPY SPIRIT ADULT DAY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1342261QA0600X
MO261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO295721401Medicaid