Provider Demographics
NPI:1134387780
Name:MERAMEC RECOVERY CENTER, INC
Entity type:Organization
Organization Name:MERAMEC RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:636-583-1785
Mailing Address - Street 1:1580 DENMARK RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-4481
Mailing Address - Country:US
Mailing Address - Phone:636-583-1785
Mailing Address - Fax:636-583-3442
Practice Address - Street 1:1580 DENMARK RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4481
Practice Address - Country:US
Practice Address - Phone:636-583-1785
Practice Address - Fax:636-583-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3067-8861251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)