Provider Demographics
NPI:1750657888
Name:INTERFAITH RESIDENCE
Entity type:Organization
Organization Name:INTERFAITH RESIDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-535-1919
Mailing Address - Street 1:1101 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-2222
Mailing Address - Country:US
Mailing Address - Phone:314-535-1919
Mailing Address - Fax:314-535-1209
Practice Address - Street 1:4385 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2703
Practice Address - Country:US
Practice Address - Phone:314-535-1919
Practice Address - Fax:314-535-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care