Provider Demographics
NPI:1982289849
Name:GRACIOUS ADULT DAYCARE LLC
Entity Type:Organization
Organization Name:GRACIOUS ADULT DAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-221-1212
Mailing Address - Street 1:3756 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4029
Mailing Address - Country:US
Mailing Address - Phone:314-328-3210
Mailing Address - Fax:
Practice Address - Street 1:3756 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4029
Practice Address - Country:US
Practice Address - Phone:314-328-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care