Healthcare Provider Details

I. General information

NPI: 1134554181
Provider Name (Legal Business Name): YOGI ADULT DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 CHIPPEWA ST SUITE 102
SAINT LOUIS MO
63116-1606
US

IV. Provider business mailing address

4365 CHIPPEWA ST SUITE 102
SAINT LOUIS MO
63116-1606
US

V. Phone/Fax

Practice location:
  • Phone: 314-696-2510
  • Fax:
Mailing address:
  • Phone: 314-696-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1128
License Number StateMO

VIII. Authorized Official

Name: MR. EDIN HALILOVIC
Title or Position: GENERAL MANAGER
Credential:
Phone: 314-696-2510