Provider Demographics
NPI:1962861823
Name:EMPAC EMPLOYMENT RESOURCES
Entity Type:Organization
Organization Name:EMPAC EMPLOYMENT RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIMMELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-239-2744
Mailing Address - Street 1:1600 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-1002
Mailing Address - Country:US
Mailing Address - Phone:636-239-2744
Mailing Address - Fax:636-390-9470
Practice Address - Street 1:1600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-1002
Practice Address - Country:US
Practice Address - Phone:636-239-2744
Practice Address - Fax:636-390-9470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPAC GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-19
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO320900000XMedicaid