Provider Demographics
NPI:1316353352
Name:THE CHILD ADVOCACY CENTER OF NORTHEAST MO
Entity type:Organization
Organization Name:THE CHILD ADVOCACY CENTER OF NORTHEAST MO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-332-0899
Mailing Address - Street 1:989 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3746
Mailing Address - Country:US
Mailing Address - Phone:636-332-0899
Mailing Address - Fax:
Practice Address - Street 1:989 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3746
Practice Address - Country:US
Practice Address - Phone:636-332-0899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health