Provider Demographics
NPI:1588796221
Name:EASTER SEALS MIDWEST
Entity Type:Organization
Organization Name:EASTER SEALS MIDWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-394-7100
Mailing Address - Street 1:13545 BARRETT PARKWAY DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:314-394-7100
Mailing Address - Fax:314-394-4007
Practice Address - Street 1:1740 S GLENSTONE
Practice Address - Street 2:SUITE S
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:314-394-7100
Practice Address - Fax:314-394-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-02-23
Deactivation Date:2011-01-06
Deactivation Code:
Reactivation Date:2015-02-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO855440103Medicaid