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General NPI Number Information
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NPI Number | 1114220779
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Entity Type | Organization
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Legal Business Name | YOUNG IN SPIRIT ADULT DAYCARE, LLC
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Dates
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Enumeration Date | 12/20/2010
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Last Update Date | 12/20/2010
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Provider Practice Location Address
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Address Line | 2639 MIAMI ST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3929
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Country | US
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Telephone | 314-802-8384
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Fax | 314-802-8385
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Provider Business Mailing Address
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Address Line | 2639 MIAMI ST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3929
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Country | US
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Telephone | 314-802-8384
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Fax | 314-802-8385
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | MS. LAURA LYNN BONE
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Credential | R,N,
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Telephone | 314-802-8384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 916
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License Number State | MO
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