NPIMap

Organization Active NPI

Magdala Foundation

  • Intellectual Disabilities Intermediate Care Facility
  • Saint Louis, MO
National Provider Identifier
1255599528
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2452 10042 Issued in MO
Legal business name
MAGDALA FOUNDATION
Practice address
4242 Russell Blvd
Saint Louis, MO 63110-3511
Phone
(314) 652-6004
Fax
(314) 652-8351
NPI assigned
May 23, 2008
Organization subpart
Yes
Parent organization
MAGDALA FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2008

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

Authorized official

Name
Mr. David Meyer
Title
Executive Director
Phone
(314) 652-6004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2452 10042 MO Primary

Addresses

Primary practice location

4242 Russell Blvd
Saint Louis, MO 63110-3511

Mailing address

4158 Lindell Blvd
Saint Louis, MO 63108-2914
Phone (314) 652-6004

Other identifiers 1

IdentifierTypeStateIssuer
112364401MedicaidMO

Other names 1

  • Russell Other name

National Provider Directory

National Provider Directory
Tax ID family
Magdala Foundation4 organizations share this tax ID, including this one
Part of
Magdala Foundation

Other organizations with this tax ID 3

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

Locations

4158 Lindell Blvd
Saint Louis, MO 63108
Phone (314) 647-3667

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1255599528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4158 LINDELL BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082914",
            "telephone_number": "314-652-6004",
            "fax_number": "314-652-8351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4242 RUSSELL BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631103511",
            "telephone_number": "314-652-6004",
            "fax_number": "314-652-8351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGDALA FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGDALA FOUNDATION",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-652-6004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "2452 10042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112364401",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russell",
            "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 May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.