Healthcare Provider Details

I. General information

NPI: 1417007675
Provider Name (Legal Business Name): B & D ADULT DAY CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6154 MADISON AVE
SAINT LOUIS MO
63134-2104
US

IV. Provider business mailing address

6154 MADISON AVE
SAINT LOUIS MO
63134-2104
US

V. Phone/Fax

Practice location:
  • Phone: 314-524-3525
  • Fax:
Mailing address:
  • Phone: 314-524-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number650
License Number StateMO

VIII. Authorized Official

Name: MR. BRYAN KEITH SANDERS SR.
Title or Position: DIRECTOR
Credential:
Phone: 314-524-3525