Provider Demographics
NPI:1760540538
Name:RESIDENTIAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:RESIDENTIAL SERVICES CORPORATION
Other - Org Name:ST ANN ASSISTED LIVING REISDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONNESS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:314-961-8000
Mailing Address - Street 1:7301 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4405
Mailing Address - Country:US
Mailing Address - Phone:314-961-8000
Mailing Address - Fax:314-423-4842
Practice Address - Street 1:10441 INTERNATIONAL PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:ST ANN
Practice Address - State:MO
Practice Address - Zip Code:63074
Practice Address - Country:US
Practice Address - Phone:314-423-0600
Practice Address - Fax:314-423-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032705310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO269980207Medicaid