Healthcare Provider Details

I. General information

NPI: 1144753609
Provider Name (Legal Business Name): GOLDEN PROTECTION ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CHAMBERS RD
SAINT LOUIS MO
63136-5523
US

IV. Provider business mailing address

2400 CHAMBERS RD
SAINT LOUIS MO
63136-5523
US

V. Phone/Fax

Practice location:
  • Phone: 314-574-6884
  • Fax:
Mailing address:
  • Phone: 314-574-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMEKA PARTEE
Title or Position: DIRECTOR
Credential:
Phone: 314-574-6884