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General NPI Number Information
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NPI Number | 1720503642
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Entity Type | Organization
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Legal Business Name | LOVE AND LAUGHTER ADULT DAY CARE
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 10134 BARON DR
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City | SAINT LOUIS
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State | MO
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Zip | 63136-5510
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Country | US
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Telephone | 314-296-0344
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Fax | 314-296-0344
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Provider Business Mailing Address
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Address Line | 10134 BARON DR
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City | SAINT LOUIS
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State | MO
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Zip | 63136-5510
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Country | US
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Telephone | 314-296-0344
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Fax |
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | TINA FOX
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Credential |
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Telephone | 314-296-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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