Provider Demographics
NPI:1750657888
Name:INTERFAITH RESIDENCE
Entity Type:Organization
Organization Name:INTERFAITH RESIDENCE
Other - Org Name:DOORWAYS SUPPORTIVE HOUSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSPEH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOELKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-535-1919
Mailing Address - Street 1:4385 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2703
Mailing Address - Country:US
Mailing Address - Phone:314-535-1919
Mailing Address - Fax:314-535-1209
Practice Address - Street 1:4385 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2703
Practice Address - Country:US
Practice Address - Phone:314-535-1919
Practice Address - Fax:314-535-1209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERFAITH RESIDENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care