Healthcare Provider Details

I. General information

NPI: 1992303903
Provider Name (Legal Business Name): SENIOR AND VETERAN ADULT DAY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12404 BLUE RIDGE EXT
GRANDVIEW MO
64030-1741
US

IV. Provider business mailing address

12404 BLUE RIDGE EXT
GRANDVIEW MO
64030-1741
US

V. Phone/Fax

Practice location:
  • Phone: 816-421-9747
  • Fax:
Mailing address:
  • Phone: 816-421-9747
  • 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: MOHAMMED S ABDULKAREEM
Title or Position: DIRECTOR
Credential:
Phone: 816-421-9747