Organization Name: | ST. ELIZABETH ADULT DAY CARE CENTER, INC. |
NPI Number: | 1013046937 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN ANTONIO MILLER (ADMINISTRATOR) |
Mailing Address: | 2142 Switzer Ave Jennings |
State: | MO US |
Postal Code: | 631363842 |
Phone Number: | 3148676511 |
Fax Number: | |
NPI Enumeration Date: | 03/05/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA0600X |
License Number: | 578 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Day Care |
Taxonomy Definition: |