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General NPI Number Information
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NPI Number | 1538545843
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Entity Type | Organization
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Legal Business Name | EEE ADULT DAY CARE & RESPITE CARE CENTER
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 1945 WOODSON RD
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City | OVERLAND
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State | MO
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Zip | 63114-5674
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Country | US
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Telephone | 314-755-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 1945 WOODSON RD
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City | OVERLAND
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State | MO
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Zip | 63114-5674
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Country | US
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Telephone | 314-755-1909
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT/ADMIN
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Name | MRS. OLUWABUNMI LYDIA BADMUS
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Credential |
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Telephone | 314-448-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1271
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 1271
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License Number State | MO
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