Provider Demographics
NPI:1790879617
Name:PRESBYTERIAN CHILDREN'S HOMES AND SERVICES
Entity Type:Organization
Organization Name:PRESBYTERIAN CHILDREN'S HOMES AND SERVICES
Other - Org Name:PRESBYTERIAN CHILDREN'S SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP - PROGRAMS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:GIEGLING
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:314-989-9727
Mailing Address - Street 1:5920 W WILLIAM CANNON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1902
Mailing Address - Country:US
Mailing Address - Phone:573-756-6744
Mailing Address - Fax:573-218-0445
Practice Address - Street 1:5920 W WILLIAM CANNON DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1902
Practice Address - Country:US
Practice Address - Phone:573-756-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 261QM0855X
MO000043689322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240009308Medicaid