Provider Demographics
NPI:1528190915
Name:STE. GENEVIEVE GROUP HOME, INC.
Entity Type:Organization
Organization Name:STE. GENEVIEVE GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-883-3074
Mailing Address - Street 1:630 POINTE BASSE DR
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1849
Mailing Address - Country:US
Mailing Address - Phone:573-883-3074
Mailing Address - Fax:573-883-9370
Practice Address - Street 1:630 POINTE BASSE DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1849
Practice Address - Country:US
Practice Address - Phone:573-883-3074
Practice Address - Fax:573-883-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities