Provider Demographics
NPI:1619587037
Name:SECURE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:SECURE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-220-1220
Mailing Address - Street 1:PO BOX 460383
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-7383
Mailing Address - Country:US
Mailing Address - Phone:636-220-1220
Mailing Address - Fax:636-220-0020
Practice Address - Street 1:134 ENCHANTED PKWY STE 203
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5495
Practice Address - Country:US
Practice Address - Phone:636-220-1220
Practice Address - Fax:636-220-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care