Provider Demographics
NPI:1750799003
Name:CHILDGARDEN CHILD DEVELOPMENT CENTER
Entity type:Organization
Organization Name:CHILDGARDEN CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-531-8148
Mailing Address - Street 1:4150 LACLEDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2813
Mailing Address - Country:US
Mailing Address - Phone:314-531-8148
Mailing Address - Fax:
Practice Address - Street 1:4150 LACLEDE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2813
Practice Address - Country:US
Practice Address - Phone:314-531-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014023327252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency