Provider Demographics
NPI:1023414893
Name:CAMBRIDGE ADULT DAY CENTER WASHINGTON LLC
Entity type:Organization
Organization Name:CAMBRIDGE ADULT DAY CENTER WASHINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-932-1449
Mailing Address - Street 1:2200 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1522
Mailing Address - Country:US
Mailing Address - Phone:314-932-1449
Mailing Address - Fax:314-932-1455
Practice Address - Street 1:2200 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1522
Practice Address - Country:US
Practice Address - Phone:314-932-1449
Practice Address - Fax:314-932-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1213261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023414893Medicaid
MO1760760219Medicaid