MEDICARE: FRIENDS FOR LIFE 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1679390330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS FOR LIFE ADULT DAY CARE LLC

Provider Business Mailing Address
First Line	:	232 MAYFAIR PLAZA SHOPPING CTR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-8009
Country	:	US
Telephone Number	:	314-685-9672
Fax Number	:	314-801-8437

Provider Business Practice Location Address
First Line	:	232 MAYFAIR PLAZA SHOPPING CTR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-8009
Country	:	US
Telephone Number	:	314-685-9672
Fax Number	:	314-801-8434

Authorized Official
Title or Position	:	CEO
Name	:	DONESHIA R SAUNDERS
Credential	:
Telephone Number	:	314-600-8105

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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