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General NPI Number Information
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NPI Number | 1669752283
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Entity Type | Organization
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Legal Business Name | A TOUCH OF CLASS ADULT DAY CARE
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 4507 OLIVE ST 4507 OLIVE ST.
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1814
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Country | US
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Telephone | 314-361-8832
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Fax | 314-361-8839
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Provider Business Mailing Address
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Address Line | 4507 OLIVE ST.
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City | ST. LOUIS
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State | MO
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Zip | 63108
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Country | US
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Telephone | 314-361-8832
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Fax | 314-361-8839
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. MARY ALICE DAVIS
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Credential | LPN
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Telephone | 314-361-8832
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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 | 007613
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License Number State | MO
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