Basic Information
| Provider Information | |||||||||
| NPI: | 1255488623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPWORTH CHILDREN & FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 N ELM AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631192418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149615718 | ||||||||
| FaxNumber: | 3149613503 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N ELM AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631192418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149615718 | ||||||||
| FaxNumber: | 3149613503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DROLLINGER | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3149183308 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | MO | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.