Provider Demographics
NPI:1912073206
Name:ALEXIAN BROTHERS COMMUNITY SERVICES OF ST. LOUIS
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS COMMUNITY SERVICES OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, ELDERLY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MULHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-771-5800
Mailing Address - Street 1:3900 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3414
Mailing Address - Country:US
Mailing Address - Phone:314-771-5800
Mailing Address - Fax:
Practice Address - Street 1:3900 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3414
Practice Address - Country:US
Practice Address - Phone:314-771-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH2609Medicare ID - Type Unspecified