Healthcare Provider Details

I. General information

NPI: 1275475535
Provider Name (Legal Business Name): FELISHA ANN BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FAIRGROUNDS RD STE 105
SAINT CHARLES MO
63301-2381
US

IV. Provider business mailing address

1000 FAIRGROUNDS RD STE 105
SAINT CHARLES MO
63301-2381
US

V. Phone/Fax

Practice location:
  • Phone: 314-546-9485
  • Fax: 636-493-0009
Mailing address:
  • Phone: 314-546-9485
  • Fax: 636-493-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: