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General NPI Number Information
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NPI Number | 1346569324
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Entity Type | Organization
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Legal Business Name | GOLDEN YEARS ADULT DAY HEALTH CARE LLC
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Dates
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Enumeration Date | 05/31/2010
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Last Update Date | 05/31/2010
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Provider Practice Location Address
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Address Line | 12257 BELLEFONTAINE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1447
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Country | US
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Telephone | 314-741-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 12257 BELLEFONTAINE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63138-1447
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Country | US
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Telephone | 314-741-8100
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. LAQUITA MUHAMMAD
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Credential |
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Telephone | 314-657-7162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 886
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 886
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License Number State | MO
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