Healthcare Provider Details

I. General information

NPI: 1245579911
Provider Name (Legal Business Name): SONSHINE ADULT DAY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 CHAMBERS RD
SAINT LOUIS MO
63136-4307
US

IV. Provider business mailing address

2003 CHAMBERS RD
SAINT LOUIS MO
63136-4307
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-1703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1065
License Number StateMO

VIII. Authorized Official

Name: MRS. AUGUSTA A MATHIS
Title or Position: OWNER
Credential:
Phone: 314-942-1703