Provider Demographics
NPI:1396739124
Name:HOWARD PARK EARLY INTERVENTION CENTER
Entity type:Organization
Organization Name:HOWARD PARK EARLY INTERVENTION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-405-2701
Mailing Address - Street 1:1078 HEADQUARTERS PARK DR.
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-1910
Mailing Address - Country:US
Mailing Address - Phone:636-405-2701
Mailing Address - Fax:636-422-1223
Practice Address - Street 1:1078 HEADQUARTERS PARK DR.
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-1910
Practice Address - Country:US
Practice Address - Phone:636-405-2701
Practice Address - Fax:636-422-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X, 225XP0200X, 235Z00000X, 335E00000X, 101Y00000X, 222Z00000X, 225000000X
MO369-8742251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO404413OtherANTHEM BLUE CROSS
MO151235OtherBLUE CROSS OF MISSOURI
MO526870OtherHEALTHLINK
618306OtherANTHEM BLUE CROSS
MO37482OtherHEALTHCARE USA
MO50373506Medicaid
MO5859240001OtherMEDICARE PTAN
MO=========HOPOtherMERCY HEALTH PLANS