Provider Demographics
NPI:1922641810
Name:EDU HEALTH PCS AND ADC
Entity Type:Organization
Organization Name:EDU HEALTH PCS AND ADC
Other - Org Name:EDU-HEALTH ADULT DAYCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NADIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-308-5219
Mailing Address - Street 1:5843 EAGLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1148
Mailing Address - Country:US
Mailing Address - Phone:314-308-5219
Mailing Address - Fax:
Practice Address - Street 1:1841 ARROWPOINT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-6313
Practice Address - Country:US
Practice Address - Phone:314-308-5219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDU HEALTH PCS AND ADC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-23
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1386122497Medicaid