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General NPI Number Information
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NPI Number | 1942506043
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Entity Type | Organization
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Legal Business Name | CIRCLE OF FRIENDS ADULT SERVICES, INC.
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 3126 ALFRED AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1912
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Country | US
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Telephone | 314-776-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 3126 ALFRED AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1912
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Country | US
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Telephone | 314-776-7888
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. REBECCA LYNN GIDDEN
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Credential |
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Telephone | 314-566-5724
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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 | 923
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License Number State | MO
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