Healthcare Provider Details

I. General information

NPI: 1235954751
Provider Name (Legal Business Name): GENUINE ADULT DAYCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 FROST AVE
BERKELEY MO
63134-1329
US

IV. Provider business mailing address

8650 FROST AVE
BERKELEY MO
63134-1329
US

V. Phone/Fax

Practice location:
  • Phone: 314-475-5500
  • Fax: 314-475-5455
Mailing address:
  • Phone: 314-475-5500
  • Fax: 314-475-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DONNA SMITH
Title or Position: OWNER
Credential:
Phone: 314-475-5500