Provider Demographics
NPI:1871898783
Name:WILLIAM MCCARTHY DELCHAMPS
Entity type:Organization
Organization Name:WILLIAM MCCARTHY DELCHAMPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-497-6331
Mailing Address - Street 1:1004 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2325
Mailing Address - Country:US
Mailing Address - Phone:314-862-1662
Mailing Address - Fax:314-862-6956
Practice Address - Street 1:1004 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-2325
Practice Address - Country:US
Practice Address - Phone:314-862-1662
Practice Address - Fax:314-862-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11784C3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness