Healthcare Provider Details

I. General information

NPI: 1114220779
Provider Name (Legal Business Name): YOUNG IN SPIRIT ADULT DAYCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 MIAMI ST
SAINT LOUIS MO
63118-3929
US

IV. Provider business mailing address

2639 MIAMI ST
SAINT LOUIS MO
63118-3929
US

V. Phone/Fax

Practice location:
  • Phone: 314-802-8384
  • Fax: 314-802-8385
Mailing address:
  • Phone: 314-802-8384
  • Fax: 314-802-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number916
License Number StateMO

VIII. Authorized Official

Name: MS. LAURA LYNN BONE
Title or Position: OWNER/PROGRAM DIRECTOR
Credential: R,N,
Phone: 314-802-8384