Healthcare Provider Details

I. General information

NPI: 1760760219
Provider Name (Legal Business Name): WASHINGTON AVENUE ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WASHINGTON AVE
SAINT LOUIS MO
63103-1522
US

IV. Provider business mailing address

11701 BORMAN DR SUITE 315
SAINT LOUIS MO
63146-4100
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-9070
  • Fax: 314-994-9912
Mailing address:
  • Phone: 314-994-9070
  • Fax: 314-994-9912

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: MR. ANDREW FELDMAN
Title or Position: PRESIDENT
Credential:
Phone: 314-994-9070