1184150302 NPI number — FAIRVIEW VILLAGE ADULT DAY CARE LLC

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 1184150302 NPI number — FAIRVIEW VILLAGE ADULT DAY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW VILLAGE ADULT DAY CARE LLC
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:
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:
1184150302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13210 CLAYTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-533-3111
Provider Business Mailing Address Fax Number:
314-533-3120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8449 JENNINGS STATION RD
Provider Second Line Business Practice Location Address:
FAIRVIEW VILLAGE ADULT DAY CARE
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-533-3111
Provider Business Practice Location Address Fax Number:
314-533-3120
Provider Enumeration Date:
05/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUDHRY
Authorized Official First Name:
ALI
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER LLC
Authorized Official Telephone Number:
314-533-3111

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , 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)





Copyright © 2007-2025 www.npivalidator.com