Provider Demographics
NPI:1538545843
Name:EEE ADULT DAY CARE & RESPITE CARE CENTER
Entity type:Organization
Organization Name:EEE ADULT DAY CARE & RESPITE CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWABUNMI
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:BADMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-448-0664
Mailing Address - Street 1:1945 WOODSON RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5674
Mailing Address - Country:US
Mailing Address - Phone:314-755-1909
Mailing Address - Fax:
Practice Address - Street 1:1945 WOODSON RD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-5674
Practice Address - Country:US
Practice Address - Phone:314-755-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1271302R00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1271OtherDEPARTMENT OF HEALTH AND SENIOR SERVICES