MEDICARE: CARE FOR LIFE ADULT DAYCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1083575724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE FOR LIFE ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	2901 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1337
Country	:	US
Telephone Number	:	314-495-0619
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1337
Country	:	US
Telephone Number	:	314-495-0619
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NATHAN WIGGINS
Credential	:
Telephone Number	:	314-495-0619

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	11/21/2025

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