Provider Demographics
NPI:1770645962
Name:UNITED CEREBRAL PALSY HEARTLAND
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY HEARTLAND
Other - Org Name:UCP HEARTLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-779-2251
Mailing Address - Street 1:4645 LAGUARDIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:MO
Mailing Address - Zip Code:63134
Mailing Address - Country:US
Mailing Address - Phone:314-994-1600
Mailing Address - Fax:314-994-0179
Practice Address - Street 1:8645 OLD BONHOMME RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3901
Practice Address - Country:US
Practice Address - Phone:314-994-1600
Practice Address - Fax:314-994-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO852639400Medicaid
MO852639418Medicaid