MEDICARE: ST. ROBERTS ADULT DAY PROGRAM

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	376J00000X	Homemaker	703	MO

General Provider Information

NPI Number	:	1942408760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ROBERTS ADULT DAY PROGRAM

Provider Business Mailing Address
First Line	:	7601 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-5001
Country	:	US
Telephone Number	:	314-961-8000
Fax Number	:	314-962-4159

Provider Business Practice Location Address
First Line	:	1424 S 1ST CAPITOL DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3702
Country	:	US
Telephone Number	:	636-916-3709
Fax Number	:

Authorized Official
Title or Position	:	COORD. CAREGIVER SUPPORT SERVICES
Name	:	MS. CHERYL WOODRUFF
Credential	:
Telephone Number	:	314-961-8000

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	08/22/2020

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