Provider Demographics
NPI:1679604318
Name:AMANDA LUCKETT MURPHY HOPEWELL CENTER
Entity Type:Organization
Organization Name:AMANDA LUCKETT MURPHY HOPEWELL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-367-7848
Mailing Address - Street 1:5701 DELMAR BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2617
Mailing Address - Country:US
Mailing Address - Phone:314-367-7848
Mailing Address - Fax:314-367-5637
Practice Address - Street 1:909 NORTH 14TH STREET
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-531-1770
Practice Address - Fax:314-241-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO560578007Medicaid
MO09380050Medicare ID - Type UnspecifiedPART -A
MO264641Medicare Oscar/Certification
MO560578007Medicaid