Provider Demographics
NPI:1073149290
Name:ULTIMATE CARE ADULT DAY CARE SERVICES LLC
Entity Type:Organization
Organization Name:ULTIMATE CARE ADULT DAY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRIKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-600-8879
Mailing Address - Street 1:1322 LEROY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1504
Mailing Address - Country:US
Mailing Address - Phone:314-600-8879
Mailing Address - Fax:
Practice Address - Street 1:1322 LEROY AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1504
Practice Address - Country:US
Practice Address - Phone:314-600-8879
Practice Address - Fax:314-228-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care