Healthcare Provider Details

I. General information

NPI: 1336457845
Provider Name (Legal Business Name): THE SANCTUARY ADULT PROGRAM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 CHAMBERS RD
SAINT LOUIS MO
63135
US

IV. Provider business mailing address

1440 CHAMBERS RD
SAINT LOUIS MO
63135
US

V. Phone/Fax

Practice location:
  • Phone: 314-521-7930
  • Fax: 314-524-3811
Mailing address:
  • Phone: 314-521-7930
  • Fax: 314-524-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number895
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number895
License Number StateMO

VIII. Authorized Official

Name: MS. JANICE MARIE WARD
Title or Position: DIRECTOR
Credential:
Phone: 314-521-7930