MEDICARE: THE LEARNING TREE INTERGENERATIONAL CENTER INC

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	261QA0600X	Adult Day Care Clinic/Center	686	MO

General Provider Information

NPI Number	:	1164621538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LEARNING TREE INTERGENERATIONAL CENTER INC

Provider Business Mailing Address
First Line	:	4430 LABADIE AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63115
Country	:	US
Telephone Number	:	314-534-0699
Fax Number	:	314-534-4575

Provider Business Practice Location Address
First Line	:	4430 LABADIE AVE
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63115
Country	:	US
Telephone Number	:	314-534-0699
Fax Number	:	314-534-4575

Authorized Official
Title or Position	:	CO FOUNDER EXECUTIVE DIRECTOR
Name	:	MRS. SHIRLEY ELIZABETH BLACK
Credential	:
Telephone Number	:	314-534-0699

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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