Provider Demographics
NPI:1871842740
Name:A M HEALTHCARE ADULT DAY CARE
Entity Type:Organization
Organization Name:A M HEALTHCARE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOWLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-831-6400
Mailing Address - Street 1:3837 VAILE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034
Mailing Address - Country:US
Mailing Address - Phone:314-831-6400
Mailing Address - Fax:314-839-1081
Practice Address - Street 1:3837 VAILE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034
Practice Address - Country:US
Practice Address - Phone:314-831-6400
Practice Address - Fax:314-839-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1052261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1052Medicaid