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General NPI Number Information
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NPI Number | 1275357840
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Entity Type | Organization
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Legal Business Name | DEJA VU HEALING HEARTS ADULT DAYCARE LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 4215 S KINGSHIGHWAY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2422
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Country | US
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Telephone | 314-882-9332
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Fax | 314-925-8180
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Provider Business Mailing Address
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Address Line | 4215 S KINGSHIGHWAY BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2422
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Country | US
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Telephone | 314-882-9332
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Fax | 314-925-8180
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Authorized Official
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Title or Position | MANGER
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Name | JANILA C LINDSEY
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Credential |
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Telephone | 314-978-9268
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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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