Provider Demographics
NPI:1801307244
Name:MIDWEST ADULT DAY CENTER, INC
Entity type:Organization
Organization Name:MIDWEST ADULT DAY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAURBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-731-1922
Mailing Address - Street 1:2940 DERHAKE RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3900
Mailing Address - Country:US
Mailing Address - Phone:314-731-1922
Mailing Address - Fax:
Practice Address - Street 1:2940 DERHAKE RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3900
Practice Address - Country:US
Practice Address - Phone:314-731-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1440261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639422884Medicaid