Healthcare Provider Details

I. General information

NPI: 1720688740
Provider Name (Legal Business Name): FAITH AND FAVOR ADULT DAY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 OLIVE BLVD
SAINT LOUIS MO
63132-2815
US

IV. Provider business mailing address

8403 OLIVE BLVD
SAINT LOUIS MO
63132-2815
US

V. Phone/Fax

Practice location:
  • Phone: 314-201-6609
  • Fax: 314-254-7343
Mailing address:
  • Phone: 314-201-6609
  • Fax: 314-254-7343

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: CHASITY ANDERSON
Title or Position: OWNER
Credential:
Phone: 314-201-6609