Healthcare Provider Details

I. General information

NPI: 1407521891
Provider Name (Legal Business Name): GOLDEN AGE ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 S OLD HIGHWAY 141
FENTON MO
63026-5702
US

IV. Provider business mailing address

1671 S OLD HIGHWAY 141
FENTON MO
63026-5702
US

V. Phone/Fax

Practice location:
  • Phone: 314-562-7051
  • Fax:
Mailing address:
  • Phone:
  • 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: TONISHA STALLINGS
Title or Position: OWNER
Credential:
Phone: 314-562-7051