MEDICARE: CAMBRIDGE AUDLT DAY CENTER MICHIGAN 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	1048	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609126838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMBRIDGE AUDLT DAY CENTER MICHIGAN LLC

Provider Business Mailing Address
First Line	:	4249 MICHIGAN AVENUE
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63111-1126
Country	:	US
Telephone Number	:	314-932-1221
Fax Number	:	314-932-1220

Provider Business Practice Location Address
First Line	:	4249 MICHIGAN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1126
Country	:	US
Telephone Number	:	314-932-1221
Fax Number	:	314-932-1220

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHRISTINE MICHELLE ZERJAV
Credential	:
Telephone Number	:	314-932-1221

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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