MEDICARE: 0CRITERION ADULT DAY CARE 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		MO

General Provider Information

NPI Number	:	1720497886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	0CRITERION ADULT DAY CARE LLC

Provider Business Mailing Address
First Line	:	10262 PAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1322
Country	:	US
Telephone Number	:	314-810-4037
Fax Number	:	314-426-1678

Provider Business Practice Location Address
First Line	:	10262 PAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1322
Country	:	US
Telephone Number	:	314-810-4037
Fax Number	:	314-426-1678

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. DONNA BECTON
Credential	:
Telephone Number	:	314-810-4037

Provider Enumeration Date	:	08/03/2014
Last Update Date	:	08/03/2014

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