Provider Demographics
NPI:1720431042
Name:BLESSED MARGARET OF CASTELLO HEALTH AND SERVICES
Entity type:Organization
Organization Name:BLESSED MARGARET OF CASTELLO HEALTH AND SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-932-5845
Mailing Address - Street 1:14 N SPRIGG ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5526
Mailing Address - Country:US
Mailing Address - Phone:573-332-1423
Mailing Address - Fax:573-332-1005
Practice Address - Street 1:14 N SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5526
Practice Address - Country:US
Practice Address - Phone:573-332-1423
Practice Address - Fax:573-332-1005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LIFE OF JESUS ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care