=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821404401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT & JOY CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2014
-----------------------------------------------------
Last Update Date | 07/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4507 OLIVE ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-454-3559
-----------------------------------------------------
Fax | 314-454-3557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4507 OLIVE ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-454-3559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | MONIQUE LACHELLE SELLERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-454-3559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 1175
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------