EASTER SEALS MIDWEST NPI 1871625582

NPI Information

NPI: 1871625582
Provider Name: EASTER SEALS MIDWEST

Former Legal Business Name: JUDEVINE CENTER FOR AUTISM

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
13545 BARRETT PKWY DRIVE
SUITE 300
BALLWIN, MO
ZIP 63021
Phone: (314) 394-7100
Get Directions

EASTER SEALS MIDWEST is a community based residential treatment facility, intellectual and/or developmental disabilities in Ballwin, MO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. EASTER SEALS MIDWEST NPI is 1871625582. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Judevine Center For Autism.

The provider's business location address is:

13545 BARRETT PKWY DRIVE
SUITE 300
BALLWIN, MO
ZIP 63021
Phone: (314) 394-7100
Fax: (314) 394-4007

The provider's authorized official is John W. Adkins .
The authorized official title is Vice President, Cfo and has the following contact phone number (314) 394-7100.

The enumeration date for this NPI number is 3/9/2007 and was last updated on 2/3/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	224Z00000X	Occupational Therapy Assistant	2010005293	MISSOURI	No
2	235Z00000X	Speech-Language Pathologist	118073	MISSOURI	No
3	101Y00000X	Counselor	2205030351	MISSOURI	No
4	225X00000X	Occupational Therapist	2001015378	MISSOURI	No
5	103K00000X	Behavior Analyst			No
6	104100000X	Social Worker	1999140934	MISSOURI	No
7	104100000X	Social Worker	001967	MISSOURI	No
8	251C00000X	Day Training, Developmentally Disabled Services			No
9	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	852794502	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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