Healthcare Provider Details

I. General information

NPI: 1265146856
Provider Name (Legal Business Name): OMNI EXPRESS ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5036 THEKLA AVE
SAINT LOUIS MO
63115-1354
US

IV. Provider business mailing address

7747 WILD PLUM AVE
SAINT LOUIS MO
63130-2727
US

V. Phone/Fax

Practice location:
  • Phone: 314-599-3037
  • Fax:
Mailing address:
  • Phone:
  • 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: JOYCE BISHOP
Title or Position: OWNER
Credential:
Phone: 314-599-3037