Provider Demographics
NPI:1508235680
Name:PAULINE'S PLACE ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:PAULINE'S PLACE ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-438-7100
Mailing Address - Street 1:8460 WATSON RD
Mailing Address - Street 2:130
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5247
Mailing Address - Country:US
Mailing Address - Phone:314-438-7100
Mailing Address - Fax:
Practice Address - Street 1:8460 WATSON RD
Practice Address - Street 2:130
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5247
Practice Address - Country:US
Practice Address - Phone:314-438-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1266261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care