Healthcare Provider Details

I. General information

NPI: 1861917759
Provider Name (Legal Business Name): FREEDOM DAY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 MERAMEC STREET
SAINT LOUIS MO
63118
US

IV. Provider business mailing address

3309 MERAMEC ST
SAINT LOUIS MO
63118-4310
US

V. Phone/Fax

Practice location:
  • Phone: 314-957-5900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number1441
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1441
License Number StateMO

VIII. Authorized Official

Name: MELONI HUDDLESTON
Title or Position: PRESIDENT
Credential: RN, BSN
Phone: 314-957-5900