Provider Demographics
NPI:1568595981
Name:YOUNG IN SPIRIT ADULT DAY CENTER
Entity Type:Organization
Organization Name:YOUNG IN SPIRIT ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-645-2411
Mailing Address - Street 1:2639 MIAMI STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3520
Mailing Address - Country:US
Mailing Address - Phone:314-645-2411
Mailing Address - Fax:314-645-2007
Practice Address - Street 1:2639 MIAMI STREET
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3520
Practice Address - Country:US
Practice Address - Phone:314-645-2411
Practice Address - Fax:314-645-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO637261QA0600X
MO1081261QA0600X
MOER019914017320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO296246002Medicaid