MEDICARE: MCCLAY ADULT DAY CENTER 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	261QA0600X	Adult Day Care Clinic/Center	1323	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346695582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCLAY ADULT DAY CENTER LLC

Provider Business Mailing Address
First Line	:	3821 MCCLAY RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-7327
Country	:	US
Telephone Number	:	636-922-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	3821 MCCLAY RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-7327
Country	:	US
Telephone Number	:	636-922-9595
Fax Number	:

Authorized Official
Title or Position	:	CEO OWNER
Name	:	MRS. JENNIFER GETTMAN
Credential	:	MA, CEO, NHA
Telephone Number	:	636-219-3114

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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