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General NPI Number Information
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NPI Number | 1386999324
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Entity Type | Organization
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Legal Business Name | FAMILY LOVE ADULT HEALTH CARE CENTER, LLC
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 286 DEBALIVIERE AVENUE
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City | ST. LOUIS
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State | MO
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Zip | 63112
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Country | US
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Telephone | 314-567-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 865 CHARLESGATE DRIVE
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City | ST. LOUIS
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State | MO
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Zip | 63132
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Country | US
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Telephone | 314-432-7727
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOYCE MARIE WILKS
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Credential |
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Telephone | 314-432-7727
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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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