=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992906937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULTCARE SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 03/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12444 LUSHER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63138-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-741-3535
-----------------------------------------------------
Fax | 314-741-3599
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12444 LUSHER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63138-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-741-3535
-----------------------------------------------------
Fax | 314-741-3599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO & PROGRAMDIRECTOR
-----------------------------------------------------
Name | MR. ARTHUR JORDAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-741-3535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 702
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------