NPIMap

Organization Active NPI

Independence Center

  • Mental Illness Community Based Residential Treatment Facility
  • Saint Louis, MO
National Provider Identifier
1174669006
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
030777 Issued in MO
Legal business name
INDEPENDENCE CENTER
Practice address
2443 Prouhet Ave
Saint Louis, MO 63114-1946
Phone
(314) 890-7100
Fax
(314) 890-7133
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Patricia Holmes
Title
Exectuve Director
Phone
(314) 880-5415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 030777 MO Primary

Addresses

Primary practice location

2443 Prouhet Ave
Saint Louis, MO 63114-1946

Mailing address

8675 Olive Blvd
Saint Louis, MO 63132-2503
Phone (314) 373-5187

Other identifiers 1

IdentifierTypeStateIssuer
267727600MedicaidMO

Other names 1

  • Jane Howell Stupp Apartments Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2013107Jane Howell Stupp Apartments2443 Prouhet, Overland, MO 63114Certificate of waiverMar 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Independence Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8675 Olive Blvd
Saint Louis, MO 63132

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1174669006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8675 OLIVE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631322503",
            "telephone_number": "314-373-5187",
            "fax_number": "314-367-5626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2443 PROUHET AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631141946",
            "telephone_number": "314-890-7100",
            "fax_number": "314-890-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "EXECTUVE DIRECTOR",
        "authorized_official_telephone_number": "314-880-5415",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MO",
            "license": "030777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267727600",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jane Howell Stupp Apartments",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jane Howell Stupp Apartments",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.