MEDICARE: LOVE SMILING FACES ADULT DAY CARE, 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	251T00000X	PACE Provider Organization	1010	MO

General Provider Information

NPI Number	:	1144595588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE SMILING FACES ADULT DAY CARE, LLC

Provider Business Mailing Address
First Line	:	9738 LACKLAND RD
Second Line	:
City	:	OVERLAND
State	:	MO
Zip	:	63114-3424
Country	:	US
Telephone Number	:	314-276-3399
Fax Number	:	314-291-0797

Provider Business Practice Location Address
First Line	:	9738 LACKLAND RD
Second Line	:
City	:	OVERLAND
State	:	MO
Zip	:	63114-3424
Country	:	US
Telephone Number	:	314-276-3399
Fax Number	:	314-291-0797

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MS. NICOLE DENISE SMITH
Credential	:
Telephone Number	:	314-276-3399

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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