Provider Demographics
NPI:1255789806
Name:TLC ADULT DAY CENTER DEXTER, LLC
Entity type:Organization
Organization Name:TLC ADULT DAY CENTER DEXTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GYURCI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-640-8105
Mailing Address - Street 1:924 DIAL DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1205
Mailing Address - Country:US
Mailing Address - Phone:314-640-8105
Mailing Address - Fax:
Practice Address - Street 1:812 W OAK ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1021
Practice Address - Country:US
Practice Address - Phone:314-640-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care