Healthcare Provider Details

I. General information

NPI: 1033772991
Provider Name (Legal Business Name): LOVING ANGELS ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 S GRAND BLVD
SAINT LOUIS MO
63111-1805
US

IV. Provider business mailing address

5411 S GRAND BLVD
SAINT LOUIS MO
63111-1805
US

V. Phone/Fax

Practice location:
  • Phone: 314-499-3405
  • Fax: 314-480-7155
Mailing address:
  • Phone: 314-499-3405
  • Fax:

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: SHERRY BROOKS
Title or Position: OWNER
Credential:
Phone: 314-499-3405