Provider Demographics
NPI:1679123962
Name:JCL ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:JCL ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-921-9448
Mailing Address - Street 1:563 HOWDERSHELL RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6401
Mailing Address - Country:US
Mailing Address - Phone:314-921-9448
Mailing Address - Fax:314-921-9440
Practice Address - Street 1:563 HOWDERSHELL RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6401
Practice Address - Country:US
Practice Address - Phone:314-921-9448
Practice Address - Fax:314-921-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care