Provider Demographics
NPI:1124869557
Name:SUPPORTING EMPTY ARMS
Entity type:Organization
Organization Name:SUPPORTING EMPTY ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:PLC
Authorized Official - Phone:314-246-9454
Mailing Address - Street 1:3 BERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1921
Mailing Address - Country:US
Mailing Address - Phone:314-246-9454
Mailing Address - Fax:
Practice Address - Street 1:3 BERRY CT
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1921
Practice Address - Country:US
Practice Address - Phone:314-246-9454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health