Healthcare Provider Details

I. General information

NPI: 1073149290
Provider Name (Legal Business Name): ULTIMATE CARE ADULT DAY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 LEROY AVE
SAINT LOUIS MO
63133-1504
US

IV. Provider business mailing address

1322 LEROY AVE
SAINT LOUIS MO
63133-1504
US

V. Phone/Fax

Practice location:
  • Phone: 314-600-8879
  • Fax: 314-228-2005
Mailing address:
  • Phone: 314-600-8879
  • 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: TERRIKAH COOK
Title or Position: OWNER
Credential:
Phone: 314-600-8879