Provider Demographics
NPI:1346695582
Name:MCCLAY ADULT DAY CENTER LLC
Entity Type:Organization
Organization Name:MCCLAY ADULT DAY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CEO, NHA
Authorized Official - Phone:636-219-3114
Mailing Address - Street 1:3821 MCCLAY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7327
Mailing Address - Country:US
Mailing Address - Phone:636-922-9595
Mailing Address - Fax:
Practice Address - Street 1:3821 MCCLAY RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7327
Practice Address - Country:US
Practice Address - Phone:636-922-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1323261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1598009185Medicaid
MOM266733401Medicaid