Healthcare Provider Details

I. General information

NPI: 1346569324
Provider Name (Legal Business Name): GOLDEN YEARS ADULT DAY HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2010
Last Update Date: 05/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12257 BELLEFONTAINE RD
SAINT LOUIS MO
63138-1447
US

IV. Provider business mailing address

12257 BELLEFONTAINE RD
SAINT LOUIS MO
63138-1447
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-8100
  • Fax:
Mailing address:
  • Phone: 314-741-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number886
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number886
License Number StateMO

VIII. Authorized Official

Name: MRS. LAQUITA MUHAMMAD
Title or Position: MEMBER
Credential:
Phone: 314-657-7162