Provider Demographics
NPI:1649339771
Name:RESIDENCIAL SERVICES CORPORATION
Entity type:Organization
Organization Name:RESIDENCIAL SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONNESS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:314-361-8000
Mailing Address - Street 1:7601 WATSON ROAD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119
Mailing Address - Country:US
Mailing Address - Phone:314-961-8000
Mailing Address - Fax:314-961-1934
Practice Address - Street 1:5890 EICHELBERGER
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109
Practice Address - Country:US
Practice Address - Phone:314-752-1901
Practice Address - Fax:314-752-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032709310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266741701Medicaid