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General NPI Number Information
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NPI Number | 1366098717
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Entity Type | Organization
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Legal Business Name | HEAVENLY HANDS ADULT DAYCARE LLC
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 12891 PENNRIDGE DR
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City | BRIDGETON
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State | MO
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Zip | 63044-1238
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Country | US
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Telephone | 314-942-9361
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Fax | 314-942-9041
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Provider Business Mailing Address
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Address Line | 12891 PENNRIDGE DR
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City | BRIDGETON
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State | MO
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Zip | 63044-1238
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Country | US
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Telephone | 314-942-9361
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Fax | 314-942-9041
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBERTA G BUCKNER
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Credential |
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Telephone | 314-853-0648
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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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