Healthcare Provider Details

I. General information

NPI: 1699293464
Provider Name (Legal Business Name): AGAPE LOVE ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-4337
US

IV. Provider business mailing address

8705 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63114-4337
US

V. Phone/Fax

Practice location:
  • Phone: 314-322-1557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1445
License Number StateMO

VIII. Authorized Official

Name: TONI KING
Title or Position: OWNER
Credential:
Phone: 314-322-1557