Provider Demographics
NPI:1134955024
Name:GENTLE HEARTS ADULT DAY CENTER LLC
Entity type:Organization
Organization Name:GENTLE HEARTS ADULT DAY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MITCHELL- JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-701-8131
Mailing Address - Street 1:826 UNION BLVD STE L113
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1040
Mailing Address - Country:US
Mailing Address - Phone:314-701-8131
Mailing Address - Fax:314-782-3455
Practice Address - Street 1:826 UNION BLVD STE L109
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1040
Practice Address - Country:US
Practice Address - Phone:314-701-8131
Practice Address - Fax:314-782-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care