JUDEVINE, INC. (NPI# 1518291418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518291418 |
| Entity Type | Organization |
| Organization Name | JUDEVINE, INC. |
| Other Organization Name | JUDEVINE CENTER FOR AUTISM |
| Practice Address |
1810 Craig Rd Ste 109 Saint Louis MO 63146-4758 |
| Practice Telephone | 8007806545 |
| Practice Fax Number | 8885074453 |
| Mailing Telephone | 8007806545 |
| Mailing Fax Number | 8885074453 |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2015-01-07 |
| Authorized Official Name | MS. REBECCA BLACKWELL (PRESIDENT/DIRECTOR) |
| Authorized Official Telephone | 8007806545 |
| Authorized Official Credential | MA, BCBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251C00000X | Day Training, Developmentally Disabled Services | Agencies | ||
| N | 251S00000X | Community/Behavioral Health | ER019910064 | MO | Agencies |
| N | 252Y00000X | Early Intervention Provider Agency | Agencies | ||
| N | 253Z00000X | In Home Supportive Care | Agencies | ||
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | ER019910064 | MO | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Judevine Center for Autism | Doing Business As Name - Organization |
| Street Address |
1810 CRAIG RD STE 109 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63146-4758 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922616721 | Lexie Morton | Behavioral Analyst | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2020-07-17 |
| 1245705532 | Sarah Beninato | Behavior Technician | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-10-12 |
| 1780175588 | Emily Schurman | Behavioral Analyst | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-05-29 |
| 1508357278 | Madison Ortega | Behavior Technician | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-05-29 |
| 1619468402 | William Warren | Behavior Technician | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-05-29 |
| 1366933269 | Tatiana Garfias | Behavior Technician | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-05-25 |
| 1629569520 | Sara Willis | Behavior Technician | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-05-25 |
| 1699266593 | Nicole Laurent | Behavior Technician | 1810 Craig Rd Ste 109, Saint Louis, MO 63146-4758 | 2018-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316553118 | Chelsea Ann Garbs | Nurse Practitioner | 1249 Woodland Point Dr Unit E, St. Louis, MO 63146 | 2020-09-17 |
| 1538790647 | Supreme Quality Care LLC | Home Health | 111 West Port Plaza, Floor 6, Maryland Heights, MO 63146 | 2020-01-28 |
| 1942854492 | Winning Hands Home Health Care Services LLC | In Home Supportive Care | 12738 Fee Fee Rd, Saint Louis, MO 63146 | 2019-08-01 |
| 1144883893 | Tylians T Smith | Physical Therapy Assistant | 12544 Fee Fee Rd, Saint Louis, MO 63146 | 2019-04-18 |
| 1528533049 | Veterans Home Care, LLC | Durable Medical Equipment & Medical Supplies | 11861 Westline Industrial Drive, Suite 750, St. Louis, MO 63146 | 2018-10-11 |
| 1417433558 | Alexandria Marie Falck | Pharmacist | 577 Mid Rivers Mall Drive, Saint Louis, MO 63146 | 2018-07-12 |
| 1043702897 | Equal Shares Parenting, LLC | Marriage & Family Therapist | 10313 Corbeil Dr., Unit D, St. Louis, MO 63146 | 2018-06-06 |
| 1588189930 | Anita Shawke | Physical Therapist | 11960 Westline Industrial Drive, Suite 201, St. Louis, MO 63146 | 2017-08-07 |
| 1174047005 | Midwest Spine & Injury Centers, Inc. | Chiropractor | 2108 Schuetz Road, Maryland Heights, MO 63146 | 2017-08-02 |
| 1447700604 | Compassus Op of Missouri LLC | Hospice Care, Community Based | 11872 Westline Industrial Dr Ste 160, Saint Louis, MO 63146 | 2016-10-11 |
| Find all providers in zip 63146 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588108336 | Wright Way Residential Living | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2115 Allen Ave, Apt A, Saint Louis, MO 63104-2630 | 2016-12-13 |
| 1952768889 | Living With Purpose | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3919 N 19th St, Saint Louis, MO 63107-2816 | 2016-01-22 |
| 1154788156 | Promise Mobility LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5 S Newstead Ave, Saint Louis, MO 63108-2213 | 2016-01-21 |
| 1013334622 | Ebony Wilson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3514 Blair Ave, Saint Louis, MO 63107-3717 | 2014-03-20 |
| 1871914515 | Donald Scales | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8543 Jane Ave, Saint Louis, MO 63121-4309 | 2013-12-24 |
| 1609218593 | Young Mens Christian Association of Greater St Louis | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1528 Locust St, Saint Louis, MO 63103-1816 | 2013-07-22 |
| 1467894535 | Sun Valley Adult Care Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1000 Saint Cyr Rd, Saint Louis, MO 63137-1733 | 2013-07-18 |
| 1477802957 | Phillips Professional Home Health Service | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8456 A Page Ave, Saint Louis, MO 63130-1055 | 2012-08-30 |
| 1013283373 | Mers/missouri Goodwill Industries | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1727 Locust St, Saint Louis, MO 63103-1703 | 2012-03-30 |
| 1720359961 | Bethesda Lutheran Communities Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5122 Amberglow Dr, Saint Louis, MO 63129-3204 | 2012-01-19 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63146 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.