Provider Demographics
NPI:1184740847
Name:ST ELIZABETH ADULT DAY OF STE GENEVIEVE
Entity type:Organization
Organization Name:ST ELIZABETH ADULT DAY OF STE GENEVIEVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SR. JOHN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPPS
Authorized Official - Phone:314-772-5107
Mailing Address - Street 1:3401 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2001
Mailing Address - Country:US
Mailing Address - Phone:314-772-5107
Mailing Address - Fax:
Practice Address - Street 1:755 MARKET ST
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1525
Practice Address - Country:US
Practice Address - Phone:573-883-7603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care