Healthcare Provider Details

I. General information

NPI: 1518452721
Provider Name (Legal Business Name): 1ST CHOICE ADULT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6344 GARESCHE AVE
JENNINGS MO
63136-3446
US

IV. Provider business mailing address

6344 GARESCHE AVE
JENNINGS MO
63136-3446
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-1127
  • Fax: 314-279-1006
Mailing address:
  • Phone: 314-942-1127
  • Fax: 314-279-1006

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: LATONYA TRANEE BAKER
Title or Position: OWNER
Credential:
Phone: 314-942-1127