Provider Demographics
NPI:1659796456
Name:LESSIE BATES DAVIS NEIGHBORHOOD HOUSE
Entity Type:Organization
Organization Name:LESSIE BATES DAVIS NEIGHBORHOOD HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:KREEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-875-2211
Mailing Address - Street 1:1200 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62205-2975
Mailing Address - Country:US
Mailing Address - Phone:618-874-0777
Mailing Address - Fax:618-874-0511
Practice Address - Street 1:1200 N 13TH ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-2975
Practice Address - Country:US
Practice Address - Phone:618-874-0777
Practice Address - Fax:618-874-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care