MEDICARE: GIFTED TOUCH ADULT DAYCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1083326870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED TOUCH ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	6600 CREST AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2604
Country	:	US
Telephone Number	:	314-614-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 CREST AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-2604
Country	:	US
Telephone Number	:	314-614-2991
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHONDA LAWANDA WILLIS
Credential	:	RN
Telephone Number	:	314-614-2991

Provider Enumeration Date	:	12/23/2022
Last Update Date	:	12/23/2022

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