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General NPI Number Information
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NPI Number | 1245973379
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Entity Type | Organization
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Legal Business Name | CIRCLE OF LIGHT ASSOCIATES
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Dates
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Enumeration Date | 04/17/2022
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Last Update Date | 04/17/2022
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Provider Practice Location Address
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Address Line | 8757 ANNETTA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63147-1602
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Country | US
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Telephone | 314-723-4652
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Fax |
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Provider Business Mailing Address
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Address Line | 552 KIMBERLY LN
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City | SAINT PETERS
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State | MO
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Zip | 63376
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Country | US
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Telephone | 314-723-4652
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CLAUDIA M JOHNSON
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Credential |
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Telephone | 314-723-4652
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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 |
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License Number State |
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