Provider Demographics
NPI:1437126208
Name:JEFFERSON MEMORIAL ASSOCIATION
Entity Type:Organization
Organization Name:JEFFERSON MEMORIAL ASSOCIATION
Other - Org Name:PRIVATE DUTY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-933-1162
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0279
Mailing Address - Country:US
Mailing Address - Phone:636-933-1548
Mailing Address - Fax:636-933-1579
Practice Address - Street 1:5 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4105
Practice Address - Country:US
Practice Address - Phone:636-933-1548
Practice Address - Fax:636-933-1579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health