Provider Demographics
NPI:1912025081
Name:THE CHILDREN'S HOME OF MISSOURI
Entity Type:Organization
Organization Name:THE CHILDREN'S HOME OF MISSOURI
Other - Org Name:CHILDREN'S HOME SOCIETY OF MO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS & FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-968-2350
Mailing Address - Street 1:9445 LITZSINGER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2113
Mailing Address - Country:US
Mailing Address - Phone:314-968-2350
Mailing Address - Fax:314-968-4239
Practice Address - Street 1:9445 LITZSINGER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2113
Practice Address - Country:US
Practice Address - Phone:314-968-2350
Practice Address - Fax:314-968-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities