Healthcare Provider Details

I. General information

NPI: 1669752283
Provider Name (Legal Business Name): A TOUCH OF CLASS ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 OLIVE ST 4507 OLIVE ST.
SAINT LOUIS MO
63108-1814
US

IV. Provider business mailing address

4507 OLIVE ST.
ST. LOUIS MO
63108
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-8832
  • Fax: 314-361-8839
Mailing address:
  • Phone: 314-361-8832
  • Fax: 314-361-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number007613
License Number StateMO

VIII. Authorized Official

Name: MRS. MARY ALICE DAVIS
Title or Position: MEMBER
Credential: LPN
Phone: 314-361-8832