Provider Demographics
NPI:1982879284
Name:PRESBYTERIAN CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:PRESBYTERIAN CHILDREN'S SERVICES
Other - Org Name:AULT ISL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-263-7044
Mailing Address - Street 1:716 N AULT ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2614
Mailing Address - Country:US
Mailing Address - Phone:660-263-7044
Mailing Address - Fax:660-263-8857
Practice Address - Street 1:1353 N WARSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1807
Practice Address - Country:US
Practice Address - Phone:314-989-9727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities