Provider Demographics
NPI:1912486093
Name:FAMILIES 1ST OF DESOTO, LLC.
Entity Type:Organization
Organization Name:FAMILIES 1ST OF DESOTO, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ANP
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:636-337-7800
Mailing Address - Street 1:127 W PRATT ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-2107
Mailing Address - Country:US
Mailing Address - Phone:636-337-7800
Mailing Address - Fax:636-586-2276
Practice Address - Street 1:127 W PRATT ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-2107
Practice Address - Country:US
Practice Address - Phone:636-337-7800
Practice Address - Fax:636-586-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538591227Medicaid