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General NPI Number Information
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NPI Number | 1568595981
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Entity Type | Organization
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Legal Business Name | YOUNG IN SPIRIT ADULT DAY CENTER
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 2639 MIAMI STREET
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3520
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Country | US
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Telephone | 314-645-2411
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Fax | 314-645-2007
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Provider Business Mailing Address
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Address Line | 2639 MIAMI STREET
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3520
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Country | US
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Telephone | 314-645-2411
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Fax | 314-645-2007
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Authorized Official
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Title or Position | REGISTERED NURSE OWNER
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Name | MS. LAURA LYNN BONE
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Credential | R.N.
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Telephone | 314-645-2411
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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 | 1081
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | ER019914017
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 637
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License Number State | MO
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