Provider Demographics
NPI:1275879298
Name:SPIRITED LIVING ADULT DAYCARE LLC
Entity Type:Organization
Organization Name:SPIRITED LIVING ADULT DAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-994-9070
Mailing Address - Street 1:11701 BORMAN DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4100
Mailing Address - Country:US
Mailing Address - Phone:314-994-9070
Mailing Address - Fax:314-994-9912
Practice Address - Street 1:2075 WALTON RD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5805
Practice Address - Country:US
Practice Address - Phone:314-942-5234
Practice Address - Fax:314-942-5239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care