Healthcare Provider Details

I. General information

NPI: 1811745151
Provider Name (Legal Business Name): ELITE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 FLORISSANT RD
NORMANDY MO
63121-2526
US

IV. Provider business mailing address

7289 NATURAL BRIDGE RD
NORMANDY MO
63121-5045
US

V. Phone/Fax

Practice location:
  • Phone: 314-405-8070
  • Fax:
Mailing address:
  • Phone: 314-488-5240
  • 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: DENISHA WINGS
Title or Position: OWNER
Credential:
Phone: 314-488-5240