Healthcare Provider Details

I. General information

NPI: 1023680527
Provider Name (Legal Business Name): SANGUINE ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 ALERT DR
SAINT LOUIS MO
63114-6301
US

IV. Provider business mailing address

1929 ALERT DR
SAINT LOUIS MO
63114-6301
US

V. Phone/Fax

Practice location:
  • Phone: 314-896-3212
  • Fax:
Mailing address:
  • Phone: 314-896-3212
  • 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: LADONNA SAMPLE
Title or Position: EMPLOYEE
Credential:
Phone: 314-896-3212