1538545843 NPI number — EEE ADULT DAY CARE & RESPITE CARE CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538545843 NPI number — EEE ADULT DAY CARE & RESPITE CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EEE ADULT DAY CARE & RESPITE CARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538545843
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 WOODSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63114-5674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-755-1909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 WOODSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63114-5674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-755-1909
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BADMUS
Authorized Official First Name:
OLUWABUNMI
Authorized Official Middle Name:
LYDIA
Authorized Official Title or Position:
VICE PRESIDENT/ADMIN
Authorized Official Telephone Number:
314-448-0664

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  1271 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 1271 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1271 . This is a "DEPARTMENT OF HEALTH AND SENIOR SERVICES" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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