National Provider Identifier Database

MAGDALA FOUNDATION
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

MAGDALA FOUNDATION
3148 S KINGSHIGHWAY BLVD
SAINT LOUIS, MO63139-1118
Phone: 314-571-9950
Fax:
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X
Adult Day Care 261QA0600X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities 320900000X

* Indicates primary specialty

NPI Profile & details for MAGDALA FOUNDATION

NPI Number 1962576033
Legal business name
LBN
MAGDALA FOUNDATION
Authorized official THOMAS MANGOGNA - (PRESIDENT/CEO)
Entity Organization
Organization subpart No
Enumeration date 11/20/2006
Last updated 07/11/2024 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • MO License #: 2452, 1460-7235
  • MO License #: 2452-10039
  • MO License #: 2452-10040
  • MO License #: 2452-10041
  • MO License #: 2452-10042
  • MO Medicaid: 112182605
  • MO Medicaid: 112182704
  • MO Medicaid: 112364401
  • MO Medicaid: 112364500
  • MO Medicaid: 852098805

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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