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General NPI Number Information
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NPI Number | 1356843486
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Entity Type | Organization
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Legal Business Name | CORICAGROUP ADULT DAYCARE LLC
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 2911 OLIVE ST
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1337
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Country | US
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Telephone | 314-309-6660
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Fax |
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Provider Business Mailing Address
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Address Line | 2722 WASHINGTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63103-1422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERICA WILLIAMS
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Credential |
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Telephone | 314-309-6660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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