Provider Demographics
NPI:1134803075
Name:BTRSTL LADUE LLC
Entity type:Organization
Organization Name:BTRSTL LADUE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DION
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFALOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-819-9727
Mailing Address - Street 1:10324 LADUE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8401
Mailing Address - Country:US
Mailing Address - Phone:314-949-2080
Mailing Address - Fax:
Practice Address - Street 1:10324 LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8401
Practice Address - Country:US
Practice Address - Phone:314-949-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder