Indepedence Center of Ste. Genevieve County LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

INDEPEDENCE CENTER OF STE. GENEVIEVE COUNTY LLC

Practice address

21530 Hwy 32
Suite B
Ste Genevieve, MO 63670-8813

Phone

(573) 883-3330

Fax

(573) 883-3332

NPI assigned

Dec 9, 2011

Last updated

Feb 20, 2013By 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

Mrs. Andrea Kay Zoellner

Title

Executive Director

Phone

(573) 883-3330

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361318400000",
    "number": "1891063400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21530 HWY 32",
            "address_2": "SUITE B",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636708813",
            "telephone_number": "573-883-3330",
            "fax_number": "573-883-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21530 HWY 32",
            "address_2": "SUITE B",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636708813",
            "telephone_number": "573-883-3330",
            "fax_number": "573-883-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPEDENCE CENTER OF STE. GENEVIEVE COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-09",
        "last_updated": "2013-02-20",
        "status": "A",
        "authorized_official_last_name": "ZOELLNER",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "573-883-3330",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; 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.