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General NPI Number Information
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NPI Number | 1518776897
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Entity Type | Organization
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Legal Business Name | WENTZVILLE ADULT DAY CENTER LLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 909 PITMAN AVE
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City | WENTZVILLE
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State | MO
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Zip | 63385-1818
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Country | US
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Telephone | 636-856-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 MCCLAY RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-7386
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Country | US
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Telephone | 314-368-3247
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Fax | 636-284-7379
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Authorized Official
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Title or Position | COO
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Name | MR. GREGORY GETTMAN
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Credential | NHA
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Telephone | 314-368-3247
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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 | NULL
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