Healthcare Provider Details

I. General information

NPI: 1578064176
Provider Name (Legal Business Name): EMMANUEL ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 04/19/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2726 DROSTE RD
SAINT CHARLES MO
63301-1504
US

IV. Provider business mailing address

2726 DROSTE RD
SAINT CHARLES MO
63301-1504
US

V. Phone/Fax

Practice location:
  • Phone: 636-395-7377
  • Fax: 636-395-7378
Mailing address:
  • Phone: 636-395-7377
  • Fax: 636-395-7378

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: YVONNE ELAINE COX
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 636-395-7377