Provider Demographics
NPI:1124358114
Name:GREAT DAY ADULT DAYCARE
Entity Type:Organization
Organization Name:GREAT DAY ADULT DAYCARE
Other - Org Name:VICTORY CHRISTIAN OUTREACH CHURCH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:314-726-2009
Mailing Address - Street 1:7091 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2347
Mailing Address - Country:US
Mailing Address - Phone:314-726-2009
Mailing Address - Fax:314-726-1530
Practice Address - Street 1:7091 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2347
Practice Address - Country:US
Practice Address - Phone:314-726-2009
Practice Address - Fax:314-726-1530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORY CHRISTIAN OUTREACH CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization