Organization
NORTHERN FAMILY ADULT DAYCARE LLC
Active
Other names
Saint Louis
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY ETIS NORTHERN (DIRECTOR)
(314) 308-9106
Entity
Organization
Contact information
Practice address
11763 BENHAM RD, SAINT LOUIS, MO 63136-6113
(314) 308-9106
Mailing address
11763 BENHAM RD, SAINT LOUIS, MO 63136-6113
(314) 308-9106
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/02/2021
Last updated
08/02/2021
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