Healthcare Provider Details

I. General information

NPI: 1497150601
Provider Name (Legal Business Name): ETERNITY ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 N SARAH ST
SAINT LOUIS MO
63113-2921
US

IV. Provider business mailing address

2402-04 SARAH
ST LOUIS MO
63113-2921
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-9025
  • Fax:
Mailing address:
  • Phone: 314-531-9025
  • 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: MS. ALVA BOST
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 314-383-5437