Provider Demographics
NPI:1811192396
Name:RONAL C BRIDEWELL CHRISTIAN ADULT DAY CARE
Entity Type:Organization
Organization Name:RONAL C BRIDEWELL CHRISTIAN ADULT DAY CARE
Other - Org Name:RCB CHRISTIAN ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:NAVEDA
Authorized Official - Last Name:BRIDEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-531-3388
Mailing Address - Street 1:2822 DR. MARTIN LUTHER KING JR. DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106
Mailing Address - Country:US
Mailing Address - Phone:314-531-3388
Mailing Address - Fax:314-531-8600
Practice Address - Street 1:2822 DR. MARTIN LUTHER KING JR. DRIVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-531-3388
Practice Address - Fax:314-531-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO664311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO296158603Medicaid