Healthcare Provider Details

I. General information

NPI: 1235619040
Provider Name (Legal Business Name): ATTENTIVE ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W TERRA LN
O FALLON MO
63366-2460
US

IV. Provider business mailing address

475 BROOKHAVEN CT
O FALLON MO
63368-9632
US

V. Phone/Fax

Practice location:
  • Phone: 636-515-7740
  • Fax: 636-590-4318
Mailing address:
  • Phone: 314-323-0669
  • Fax: 636-590-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1526
License Number StateMO

VIII. Authorized Official

Name: DR. VEDA E LEWIS-SIMMONS
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: MHA, DPM
Phone: 314-323-0669