Provider Demographics
NPI:1710369608
Name:FRESH START ADULT DAY CARE OF MISSOURI INC
Entity Type:Organization
Organization Name:FRESH START ADULT DAY CARE OF MISSOURI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KALEEM
Authorized Official - Middle Name:UDDIN
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-289-7500
Mailing Address - Street 1:2700 LACEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3545
Mailing Address - Country:US
Mailing Address - Phone:573-289-7500
Mailing Address - Fax:
Practice Address - Street 1:111-113 ST MAIN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360
Practice Address - Country:US
Practice Address - Phone:660-647-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1247261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care