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General NPI Number Information
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NPI Number | 1194953968
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Entity Type | Organization
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Legal Business Name | TR ADULT CARE AND RECREATION CENTER/IN HOME SERVICE
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 1628 N 14TH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63106-4107
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Country | US
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Telephone | 314-436-7447
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Fax |
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Provider Business Mailing Address
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Address Line | 1628 N 14TH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63106-4107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. JIMMIE L MANN
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Credential |
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Telephone | 314-436-7447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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