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General NPI Number Information
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NPI Number | 1043587736
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Entity Type | Organization
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Legal Business Name | ANGELS ADULT DAY CARE
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 5021 NORTHLAND AVENUE
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City | SAINT LOUIS
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State | MO
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Zip | 63113
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Country | US
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Telephone | 314-383-7310
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Fax | 314-383-1713
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Provider Business Mailing Address
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Address Line | 5021 NORTHLAND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63113-1014
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Country | US
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Telephone | 314-383-7310
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Fax | 314-383-1713
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Authorized Official
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Title or Position | MANAGER
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Name | MS. ALMA COOK
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Credential |
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Telephone | 314-383-7310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 975
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License Number State | MO
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