Healthcare Provider Details

I. General information

NPI: 1699188565
Provider Name (Legal Business Name): SENIOR TRANSITIONAL ACCOMMODATIONS & RECREATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 06/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6344 GARESCHE AVE
SAINT LOUIS MO
63136-3446
US

IV. Provider business mailing address

6344 GARESCHE AVE
SAINT LOUIS MO
63136-3446
US

V. Phone/Fax

Practice location:
  • Phone: 314-382-2560
  • Fax: 314-382-2560
Mailing address:
  • Phone: 314-382-2560
  • Fax: 314-382-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1180
License Number StateMO

VIII. Authorized Official

Name: MISS ALICE I. LOGAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 314-382-2560