Provider Demographics
NPI:1861549412
Name:BON VIVANT ADULT DAY CLUB L.L.C.
Entity type:Organization
Organization Name:BON VIVANT ADULT DAY CLUB L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-343-1600
Mailing Address - Street 1:1525 BOWLES AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026
Mailing Address - Country:US
Mailing Address - Phone:636-343-1600
Mailing Address - Fax:636-343-1496
Practice Address - Street 1:1525 BOWLES AVE.
Practice Address - Street 2:STE A
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026
Practice Address - Country:US
Practice Address - Phone:636-343-1600
Practice Address - Fax:636-343-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO652261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care