NPIMap

Organization Active NPI

Magdala Foundation

  • Intellectual Disabilities Intermediate Care Facility
  • Saint Louis, MO
National Provider Identifier
1962576033
Registry record updated Jul 11, 2024
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
3148 S Kingshighway Blvd
Saint Louis, MO 63139-1118
Phone
(314) 571-9950
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Thomas Mangogna
Title
President/Ceo
Phone
(314) 652-6004

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X
Intellectual Disabilities Intermediate Care Facility 315P00000X 2452-10039 MO
Intellectual Disabilities Intermediate Care Facility 315P00000X 2452-10040 MO
Intellectual Disabilities Intermediate Care Facility 315P00000X 2452-10041 MO
Intellectual Disabilities Intermediate Care Facility 315P00000X 2452-10042 MO Primary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 2452, 1460-7235 MO

Addresses

Primary practice location

3148 S Kingshighway Blvd
Saint Louis, MO 63139-1118

Mailing address

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

Other practice location 1

4158 Lindell Blvd
Saint Louis, MO 63108-2914
Phone (314) 652-6004 ext. 3008

Other identifiers 5

IdentifierTypeStateIssuer
852098805MedicaidMO
112364401MedicaidMO
112364500MedicaidMO
112182704MedicaidMO
112182605MedicaidMO

National Provider Directory

National Provider Directory

Locations

3148 S Kingshighway Blvd
Saint Louis, MO 63139
Phone (314) 571-9950

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1962576033",
    "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": "3148 S KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631391118",
            "telephone_number": "314-571-9950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4158 Lindell Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631082914",
            "country_code": "US",
            "telephone_number": "314-652-6004 x3008",
            "fax_number": "314-652-8351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAGDALA FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "MANGOGNA",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "314-652-6004"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "2452-10039",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "2452-10040",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "2452-10041",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "2452-10042",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "2452, 1460-7235",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852098805",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112364401",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112364500",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112182704",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112182605",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 11, 2024; 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.