Provider Demographics
NPI:1629427042
Name:QUEEN OF PEACE CENTER
Entity Type:Organization
Organization Name:QUEEN OF PEACE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:314-531-0511
Mailing Address - Street 1:325 N NEWSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2707
Mailing Address - Country:US
Mailing Address - Phone:314-531-0511
Mailing Address - Fax:314-652-2637
Practice Address - Street 1:325 N NEWSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2707
Practice Address - Country:US
Practice Address - Phone:314-531-0511
Practice Address - Fax:314-652-2637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
MO00261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health