Provider Demographics
NPI:1578899852
Name:ULTIMATE CARE ADULT DAY CARE
Entity Type:Organization
Organization Name:ULTIMATE CARE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AYUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-802-7126
Mailing Address - Street 1:2905 N KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-1618
Mailing Address - Country:US
Mailing Address - Phone:314-802-7126
Mailing Address - Fax:
Practice Address - Street 1:2905 N KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1618
Practice Address - Country:US
Practice Address - Phone:314-802-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0994486261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care