Healthcare Provider Details

I. General information

NPI: 1376155390
Provider Name (Legal Business Name): A ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 MICHIGAN AVE
SAINT LOUIS MO
63111-2546
US

IV. Provider business mailing address

6201 MICHIGAN AVE
SAINT LOUIS MO
63111-2546
US

V. Phone/Fax

Practice location:
  • Phone: 314-269-6907
  • Fax:
Mailing address:
  • Phone: 314-269-6907
  • 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: LISA L GREGORY
Title or Position: OWNER
Credential:
Phone: 314-269-6907