Provider Demographics
NPI:1235619040
Name:ATTENTIVE ADULT DAY CENTER
Entity Type:Organization
Organization Name:ATTENTIVE ADULT DAY CENTER
Other - Org Name:ATTENTIVE ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEWIS-SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, DPM
Authorized Official - Phone:314-323-0669
Mailing Address - Street 1:475 BROOKHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-9632
Mailing Address - Country:US
Mailing Address - Phone:314-323-0669
Mailing Address - Fax:636-590-4318
Practice Address - Street 1:822 W TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2460
Practice Address - Country:US
Practice Address - Phone:636-515-7740
Practice Address - Fax:636-590-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1526261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care