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General NPI Number Information
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NPI Number | 1609126838
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE AUDLT DAY CENTER MICHIGAN LLC
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 4249 MICHIGAN AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1126
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Country | US
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Telephone | 314-932-1221
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Fax | 314-932-1220
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Provider Business Mailing Address
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Address Line | 4249 MICHIGAN AVENUE
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City | ST. LOUIS
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State | MO
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Zip | 63111-1126
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Country | US
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Telephone | 314-932-1221
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Fax | 314-932-1220
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CHRISTINE MICHELLE ZERJAV
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Credential |
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Telephone | 314-932-1221
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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 | 1048
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License Number State | MO
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