Provider Demographics
NPI:1548748148
Name:AMAZING TIMES, LLC
Entity Type:Organization
Organization Name:AMAZING TIMES, LLC
Other - Org Name:AMAZING TIMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-283-0139
Mailing Address - Street 1:800 N TUCKER BLVD STE 454
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9921 HOLTWICK AVE
Practice Address - Street 2:
Practice Address - City:ST ANN
Practice Address - State:MO
Practice Address - Zip Code:63074
Practice Address - Country:US
Practice Address - Phone:314-283-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care