Provider Demographics
NPI:1497585301
Name:UNFAILING LOVE CRC (COMMUNITY RESOURCE CENTER)
Entity type:Organization
Organization Name:UNFAILING LOVE CRC (COMMUNITY RESOURCE CENTER)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-604-4561
Mailing Address - Street 1:15563 CHASTE ST
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2173
Mailing Address - Country:US
Mailing Address - Phone:314-226-9705
Mailing Address - Fax:
Practice Address - Street 1:4068 MAFFITT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3235
Practice Address - Country:US
Practice Address - Phone:314-226-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty