Healthcare Provider Details

I. General information

NPI: 1144803545
Provider Name (Legal Business Name): RELIABLE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 TELEGRAPH RD
SAINT LOUIS MO
63125-4061
US

IV. Provider business mailing address

2934 TELEGRAPH RD
SAINT LOUIS MO
63125-4061
US

V. Phone/Fax

Practice location:
  • Phone: 314-546-0298
  • Fax:
Mailing address:
  • Phone:
  • 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: MS. DEANSHAY WARE
Title or Position: OWNER
Credential:
Phone: 314-546-0298