Provider Demographics
| NPI: | 1083934889 |
|---|---|
| Name: | L'ARCHE ST. LOUIS, INC |
| Entity type: | Organization |
| Organization Name: | L'ARCHE ST. LOUIS, INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | PAULA |
| Authorized Official - Middle Name: | KATHLEEN |
| Authorized Official - Last Name: | KILCOYNE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MSW |
| Authorized Official - Phone: | 314-395-5851 |
| Mailing Address - Street 1: | 9445 LITZSINGER ROAD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BRENTWOOD |
| Mailing Address - State: | MO |
| Mailing Address - Zip Code: | 63144 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 314-395-5851 |
| Mailing Address - Fax: | 314-492-8685 |
| Practice Address - Street 1: | 9445 LITZSINGER ROAD |
| Practice Address - Street 2: | |
| Practice Address - City: | BRENTWOOD |
| Practice Address - State: | MO |
| Practice Address - Zip Code: | 63144 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 314-395-5851 |
| Practice Address - Fax: | 314-492-8685 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-06-03 |
| Last Update Date: | 2022-01-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |