Healthcare Provider Details

I. General information

NPI: 1679393201
Provider Name (Legal Business Name): BRENTWOOD ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 S BRENTWOOD BLVD
BRENTWOOD MO
63144-2309
US

IV. Provider business mailing address

2570 S BRENTWOOD BLVD
BRENTWOOD MO
63144-2309
US

V. Phone/Fax

Practice location:
  • Phone: 314-517-1743
  • Fax:
Mailing address:
  • Phone: 314-517-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMIAKIA WARD
Title or Position: DIRECTOR
Credential:
Phone: 314-517-1743