Healthcare Provider Details

I. General information

NPI: 1922641810
Provider Name (Legal Business Name): EDU HEALTH PCS AND ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 ARROWPOINT DR
SAINT LOUIS MO
63138-6313
US

IV. Provider business mailing address

5843 EAGLE VALLEY DR
SAINT LOUIS MO
63136-1148
US

V. Phone/Fax

Practice location:
  • Phone: 314-308-5219
  • Fax:
Mailing address:
  • Phone: 314-308-5219
  • 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: NADIYAH BRANDON
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-308-5219