Provider Demographics
NPI:1477831576
Name:THE KING'S OUTREACH MINISTRY
Entity Type:Organization
Organization Name:THE KING'S OUTREACH MINISTRY
Other - Org Name:THE KING'S ADULT DAYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-727-7015
Mailing Address - Street 1:7330 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1701
Mailing Address - Country:US
Mailing Address - Phone:314-725-8116
Mailing Address - Fax:314-727-7015
Practice Address - Street 1:7330 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1701
Practice Address - Country:US
Practice Address - Phone:314-725-8116
Practice Address - Fax:314-727-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO960261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care