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General NPI Number Information
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NPI Number | 1255789806
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Entity Type | Organization
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Legal Business Name | TLC ADULT DAY CENTER DEXTER, LLC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 812 W OAK ST
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City | DEXTER
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State | MO
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Zip | 63841-1021
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Country | US
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Telephone | 314-640-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 924 DIAL DR
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City | KENNETT
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State | MO
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Zip | 63857-1205
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Country | US
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Telephone | 314-640-8105
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. LUCINDA ANN GYURCI
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Credential | R.PH.
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Telephone | 314-640-8105
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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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