Edgewood Childrens Center

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

EDGEWOOD CHILDRENS CENTER

Practice address

330 N Gore Ave
Saint Louis, MO 63119-1600

Phone

(314) 968-2020

Fax

(314) 968-8308

NPI assigned

Mar 23, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Latriece Kimbrough

Title

Cfo

Phone

(314) 968-2060

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659498996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N GORE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631191600",
            "telephone_number": "314-968-2020",
            "fax_number": "314-968-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N GORE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631191600",
            "telephone_number": "314-968-2020",
            "fax_number": "314-968-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD CHILDRENS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIMBROUGH",
        "authorized_official_first_name": "LATRIECE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-968-2060"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edens Sacred Hand Homecare, LLC
• Stacey Lynn Ederer
• Julia D Edgar, MA
• Randall C Edgell, MD
• Tyler I Edgerton
• Chris K Edler, CRNA
• Michael Edlin Jr., D.M.D
• Edward James Edmonds, HT, QIHC
• McCoy Edmonds, LCSW
• Mia Brianna Edmonds

• Emotionally Disturbed Childrens' Residential Treatment Facility in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.