Provider Demographics
NPI:1699121475
Name:COMMUNITY AND LONG-TERM CARE PSYCHIATRY LLC
Entity type:Organization
Organization Name:COMMUNITY AND LONG-TERM CARE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GRAYPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-267-1075
Mailing Address - Street 1:10004 KENNERLY RD STE 362B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2178
Mailing Address - Country:US
Mailing Address - Phone:314-525-5050
Mailing Address - Fax:314-525-5072
Practice Address - Street 1:10004 KENNERLY RD STE 362B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2178
Practice Address - Country:US
Practice Address - Phone:314-525-5050
Practice Address - Fax:314-525-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150026342084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1265723407Medicaid
MO156440095OtherMEDICARE
MOP01585490OtherRR MEDICARE