Provider Demographics
NPI:1235823758
Name:FORGET ME NOT ADULT DAY SERVICES
Entity Type:Organization
Organization Name:FORGET ME NOT ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAM MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLLORA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:636-244-0291
Mailing Address - Street 1:4126 TOWERS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7416
Mailing Address - Country:US
Mailing Address - Phone:314-497-5925
Mailing Address - Fax:
Practice Address - Street 1:1225 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6941
Practice Address - Country:US
Practice Address - Phone:636-244-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care