Provider Demographics
NPI:1255878625
Name:PETER & PAUL COMMUNITY SERVICE
Entity type:Organization
Organization Name:PETER & PAUL COMMUNITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CISROE
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:314-338-8166
Mailing Address - Street 1:2612 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2402
Mailing Address - Country:US
Mailing Address - Phone:314-338-8177
Mailing Address - Fax:314-621-9875
Practice Address - Street 1:2612 WYOMING ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-2402
Practice Address - Country:US
Practice Address - Phone:314-338-8177
Practice Address - Fax:314-621-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health