Healthcare Provider Details

I. General information

NPI: 1518776897
Provider Name (Legal Business Name): WENTZVILLE ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PITMAN AVE
WENTZVILLE MO
63385-1818
US

IV. Provider business mailing address

3821 MCCLAY RD
SAINT PETERS MO
63376-7386
US

V. Phone/Fax

Practice location:
  • Phone: 636-856-0136
  • Fax:
Mailing address:
  • Phone: 314-368-3247
  • Fax: 636-284-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GREGORY GETTMAN
Title or Position: COO
Credential: NHA
Phone: 314-368-3247