Provider Demographics
NPI:1821019936
Name:CENTREC CARE
Entity Type:Organization
Organization Name:CENTREC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-205-8068
Mailing Address - Street 1:1224 FERN RIDGE PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-4404
Mailing Address - Country:US
Mailing Address - Phone:314-205-8068
Mailing Address - Fax:314-469-4507
Practice Address - Street 1:1224 FERN RIDGE PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-4404
Practice Address - Country:US
Practice Address - Phone:314-205-8068
Practice Address - Fax:314-469-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3140-9189261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)