Provider Demographics
NPI:1508290958
Name:LIFE CHANGING HOME HEALTH & ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:LIFE CHANGING HOME HEALTH & ADULT DAY CARE, INC.
Other - Org Name:LIFE CHANGING ADULT DAY CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-279-4663
Mailing Address - Street 1:104 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1608
Mailing Address - Country:US
Mailing Address - Phone:636-279-4663
Mailing Address - Fax:636-279-4663
Practice Address - Street 1:104 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1608
Practice Address - Country:US
Practice Address - Phone:636-279-4663
Practice Address - Fax:636-279-4663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1095261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care