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General NPI Number Information
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NPI Number | 1871831339
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Entity Type | Organization
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Legal Business Name | ST. ELIZABETH ADULT DAY CARE CENTER INC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 1424 S 1ST CAPITOL DR
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3702
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Country | US
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Telephone | 636-724-2110
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Fax | 636-724-2110
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Provider Business Mailing Address
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Address Line | 3683 COOK AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63113-3831
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Country | US
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Telephone | 314-772-5107
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Fax | 314-772-3674
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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 | CPPS
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1076
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License Number State | MO
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