Healthcare Provider Details

I. General information

NPI: 1295105054
Provider Name (Legal Business Name): YOUTHFUL YOU ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 NATURAL BRIDGE
PINELAWN MO
63121
US

IV. Provider business mailing address

5199 LONGHORN TRAIL
FLORISSANT MO
63033
US

V. Phone/Fax

Practice location:
  • Phone: 314-629-7876
  • Fax:
Mailing address:
  • Phone: 314-629-7876
  • 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: MS. YOLANDA PHILLIPS
Title or Position: OWNER
Credential: NURSE
Phone: 314-629-7876