Provider Demographics
NPI:1336457845
Name:THE SANCTUARY ADULT PROGRAM, LLC
Entity Type:Organization
Organization Name:THE SANCTUARY ADULT PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-521-7930
Mailing Address - Street 1:1440 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135
Mailing Address - Country:US
Mailing Address - Phone:314-521-7930
Mailing Address - Fax:314-524-3811
Practice Address - Street 1:1440 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135
Practice Address - Country:US
Practice Address - Phone:314-521-7930
Practice Address - Fax:314-524-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO895251C00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care