Healthcare Provider Details

I. General information

NPI: 1710810825
Provider Name (Legal Business Name): TIA'S ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E ELM ST
ALTON IL
62002-5201
US

IV. Provider business mailing address

14623 ROUVRE DR
FLORISSANT MO
63034-2317
US

V. Phone/Fax

Practice location:
  • Phone: 314-441-1923
  • Fax:
Mailing address:
  • Phone: 314-441-1923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TILWUANA WELLS
Title or Position: OWNER
Credential: PLBA
Phone: 314-441-1923