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General NPI Number Information
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NPI Number | 1710369608
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Entity Type | Organization
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Legal Business Name | FRESH START ADULT DAY CARE OF MISSOURI INC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 111-113 ST MAIN
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City | WINDSOR
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State | MO
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Zip | 65360
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Country | US
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Telephone | 660-647-0207
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 LACEWOOD DR
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City | COLUMBIA
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State | MO
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Zip | 65201-3545
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Country | US
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Telephone | 573-289-7500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | KALEEM UDDIN SYED
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Credential | M.D
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Telephone | 573-289-7500
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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 | 1247
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License Number State | MO
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