MEDICARE: SURE CARE EXCEL 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

General Provider Information

NPI Number	:	1366723421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURE CARE EXCEL INC

Provider Business Mailing Address
First Line	:	1197 ST. CHARLES ROCK ROAD
Second Line	:	SUITE 121
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2637
Country	:	US
Telephone Number	:	314-291-5210
Fax Number	:	314-291-5219

Provider Business Practice Location Address
First Line	:	1197 ST. CHARLES ROCK ROAD
Second Line	:	SUITE 121
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2637
Country	:	US
Telephone Number	:	314-291-5210
Fax Number	:	314-291-5219

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. DEBORAH E MABRIE
Credential	:
Telephone Number	:	314-291-5210

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	05/23/2019

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