Healthcare Provider Details

I. General information

NPI: 1255789806
Provider Name (Legal Business Name): TLC ADULT DAY CENTER DEXTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W OAK ST
DEXTER MO
63841-1021
US

IV. Provider business mailing address

924 DIAL DR
KENNETT MO
63857-1205
US

V. Phone/Fax

Practice location:
  • Phone: 314-640-8105
  • Fax:
Mailing address:
  • Phone: 314-640-8105
  • 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: MS. LUCINDA ANN GYURCI
Title or Position: OWNER/MANAGER
Credential: R.PH.
Phone: 314-640-8105