MEDICARE: FRANCENE WALLACE

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	:	1598259798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCENE WALLACE

Provider Business Mailing Address
First Line	:	1131 MEYER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-1826
Country	:	US
Telephone Number	:	314-732-9159
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 MEYER ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-1826
Country	:	US
Telephone Number	:	314-732-9159
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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Directions to “ FRANCENE WALLACE ” Practice Location

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