Provider Demographics
NPI:1467900340
Name:THE COMMUNITY
Entity Type:Organization
Organization Name:THE COMMUNITY
Other - Org Name:BTMB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, EDD, RSAP
Authorized Official - Phone:314-580-3029
Mailing Address - Street 1:8936 GOODFELLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1433
Mailing Address - Country:US
Mailing Address - Phone:314-580-3029
Mailing Address - Fax:
Practice Address - Street 1:8936 GOODFELLOW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63147-1433
Practice Address - Country:US
Practice Address - Phone:314-580-3029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225C00000X225C00000X
MO305S00000X305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9374OtherRSAP