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General NPI Number Information
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NPI Number | 1346886488
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Entity Type | Organization
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Legal Business Name | CELEBRATION CITY COMMUNITY CENTER
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 4130 E LEXINGTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63115-3333
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Country | US
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Telephone | 314-261-4348
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Fax | 313-449-1338
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Provider Business Mailing Address
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Address Line | 1703 STONEY TERRACE DR
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City | BALLWIN
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State | MO
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Zip | 63021-7783
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Country | US
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Telephone | 314-761-6132
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Fax | 314-449-1338
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. PRIENTISS THOMAS
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Credential | BS THEOLOGY, D. DIVI
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Telephone | 314-761-6132
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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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