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General NPI Number Information
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NPI Number | 1801925664
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Entity Type | Organization
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Legal Business Name | ST ELIZABETH ADULT DAY CARE CENTER
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9723 GRANDVIEW DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-2006
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Country | US
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Telephone | 314-664-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 ARSENAL ST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-2001
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Country | US
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Telephone | 314-772-5107
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHN ANTONIO MILLER
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Credential | C.PP.S. (SISTER)
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Telephone | 314-772-5107
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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 | 625
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License Number State | MO
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