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General NPI Number Information
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NPI Number | 1548748148
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Entity Type | Organization
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Legal Business Name | AMAZING TIMES, LLC
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 9921 HOLTWICK AVE
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City | ST ANN
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State | MO
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Zip | 63074
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Country | US
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Telephone | 314-283-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 800 N TUCKER BLVD STE 454
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City | SAINT LOUIS
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State | MO
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Zip | 63101-1000
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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 | MEMBER
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Name | MRS. HENRIETTA Y GLADNEY
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Credential |
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Telephone | 314-283-0139
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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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