Provider Demographics
NPI:1871831339
Name:ST. ELIZABETH ADULT DAY CARE CENTER INC
Entity Type:Organization
Organization Name:ST. ELIZABETH ADULT DAY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPPS
Authorized Official - Phone:314-772-5107
Mailing Address - Street 1:3683 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-3831
Mailing Address - Country:US
Mailing Address - Phone:314-772-5107
Mailing Address - Fax:314-772-3674
Practice Address - Street 1:1424 S 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3702
Practice Address - Country:US
Practice Address - Phone:636-724-2110
Practice Address - Fax:636-724-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1076311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013046937OtherNPI
MO1619006467OtherNPI
MO1184740847OtherNPI
MO1407986847OtherNPI
MO1801925664OtherNPI
MO1487783254OtherNPI
MO1730218660OtherNPI