Healthcare Provider Details

I. General information

NPI: 1821404401
Provider Name (Legal Business Name): COMFORT & JOY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4507 OLIVE ST
SAINT LOUIS MO
63108-1814
US

IV. Provider business mailing address

4507 OLIVE ST
SAINT LOUIS MO
63108-1814
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-3559
  • Fax: 314-454-3557
Mailing address:
  • Phone: 314-454-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1175
License Number StateMO

VIII. Authorized Official

Name: MONIQUE LACHELLE SELLERS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 314-454-3559