Provider Demographics
NPI:1104354018
Name:COMMUNITY BEHAVIOR HEALTH
Entity type:Organization
Organization Name:COMMUNITY BEHAVIOR HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-282-0804
Mailing Address - Street 1:1027 S VANDEVENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3800
Mailing Address - Country:US
Mailing Address - Phone:314-833-3424
Mailing Address - Fax:
Practice Address - Street 1:1027 S VANDEVENTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3800
Practice Address - Country:US
Practice Address - Phone:314-282-0804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY BEHAVIOR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO114354018Medicaid
MO1588094312Medicaid