Provider Demographics
NPI:1184150302
Name:FAIRVIEW VILLAGE ADULT DAY CARE LLC
Entity type:Organization
Organization Name:FAIRVIEW VILLAGE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-533-3111
Mailing Address - Street 1:13210 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1001
Mailing Address - Country:US
Mailing Address - Phone:314-533-3111
Mailing Address - Fax:314-533-3120
Practice Address - Street 1:8449 JENNINGS STATION RD
Practice Address - Street 2:FAIRVIEW VILLAGE ADULT DAY CARE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-533-3111
Practice Address - Fax:314-533-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care