Healthcare Provider Details

I. General information

NPI: 1164621538
Provider Name (Legal Business Name): THE LEARNING TREE INTERGENERATIONAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 LABADIE AVE
ST LOUIS MO
63115
US

IV. Provider business mailing address

4430 LABADIE AVE
ST LOUIS MO
63115
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-0699
  • Fax: 314-534-4575
Mailing address:
  • Phone: 314-534-0699
  • Fax: 314-534-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number686
License Number StateMO

VIII. Authorized Official

Name: MRS. SHIRLEY ELIZABETH BLACK
Title or Position: CO FOUNDER EXECUTIVE DIRECTOR
Credential:
Phone: 314-534-0699