=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225446610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMBRIDGE ADULT DAY CENTER WALTON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 02/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2075 WALTON RD
-----------------------------------------------------
City | OVERLAND
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63114-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-426-7777
-----------------------------------------------------
Fax | 800-361-2345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2075 WALTON RD
-----------------------------------------------------
City | OVERLAND
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63114-5805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-426-7777
-----------------------------------------------------
Fax | 800-361-2345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. RICHARD G BRIGGS
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 314-426-7777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 1267
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------