Provider Demographics
NPI:1679616742
Name:GERMANN, ARLENE CAPISTRANO (ISL OWNER DIRECTOR)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:CAPISTRANO
Last Name:GERMANN
Suffix:
Gender:F
Credentials:ISL OWNER DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:MO
Mailing Address - Zip Code:64633
Mailing Address - Country:US
Mailing Address - Phone:660-542-8707
Mailing Address - Fax:660-542-8707
Practice Address - Street 1:1102 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:MO
Practice Address - Zip Code:64633
Practice Address - Country:US
Practice Address - Phone:660-542-8707
Practice Address - Fax:660-542-8707
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0298001812322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children