Healthcare Provider Details

I. General information

NPI: 1083326870
Provider Name (Legal Business Name): GIFTED TOUCH ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 CREST AVE
SAINT LOUIS MO
63130-2604
US

IV. Provider business mailing address

6600 CREST AVE
SAINT LOUIS MO
63130-2604
US

V. Phone/Fax

Practice location:
  • Phone: 314-614-2991
  • Fax:
Mailing address:
  • Phone: 314-614-2991
  • 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: JOHONDA LAWANDA WILLIS
Title or Position: OWNER
Credential: RN
Phone: 314-614-2991