Provider Demographics
NPI:1578737490
Name:SAFETY COUNCIL OF GREATER ST. LOUIS
Entity Type:Organization
Organization Name:SAFETY COUNCIL OF GREATER ST. LOUIS
Other - Org Name:SAFETY COUNCIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAGGI
Authorized Official - Suffix:
Authorized Official - Credentials:CSP
Authorized Official - Phone:314-621-9200
Mailing Address - Street 1:2330 HAMPTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2909
Mailing Address - Country:US
Mailing Address - Phone:314-621-9200
Mailing Address - Fax:314-621-9204
Practice Address - Street 1:2330 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2909
Practice Address - Country:US
Practice Address - Phone:314-621-9200
Practice Address - Fax:314-621-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder