Provider Demographics
NPI:1780801837
Name:HANDICAP FACILITIES OF ST CHARLES COUNTY
Entity type:Organization
Organization Name:HANDICAP FACILITIES OF ST CHARLES COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOELKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:636-939-3351
Mailing Address - Street 1:156 ST PETERS CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1695
Mailing Address - Country:US
Mailing Address - Phone:636-939-3351
Mailing Address - Fax:636-939-3988
Practice Address - Street 1:156 ST PETERS CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1695
Practice Address - Country:US
Practice Address - Phone:636-939-3351
Practice Address - Fax:636-939-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO156242901Medicaid