Healthcare Provider Details

I. General information

NPI: 1437517414
Provider Name (Legal Business Name): ALL GENERATIONS ADULT DAY CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 EXCHANGE DR
SAINT CHARLES MO
63303-5987
US

IV. Provider business mailing address

2061 EXCHANGE DR
SAINT CHARLES MO
63303-5987
US

V. Phone/Fax

Practice location:
  • Phone: 636-410-8303
  • Fax: 636-410-7707
Mailing address:
  • Phone: 636-410-8303
  • Fax: 636-410-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TIFFANY RENEE MAYS
Title or Position: PROGRAM DIRECTOR
Credential: B.S.
Phone: 636-410-8303