Provider Demographics
NPI:1346569324
Name:GOLDEN YEARS ADULT DAY HEALTH CARE LLC
Entity Type:Organization
Organization Name:GOLDEN YEARS ADULT DAY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-657-7162
Mailing Address - Street 1:12257 BELLEFONTAINE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1447
Mailing Address - Country:US
Mailing Address - Phone:314-741-8100
Mailing Address - Fax:
Practice Address - Street 1:12257 BELLEFONTAINE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1447
Practice Address - Country:US
Practice Address - Phone:314-741-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO886261QA0600X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health