Provider Demographics
NPI:1275357840
Name:DEJA VU HEALING HEARTS ADULT DAYCARE LLC
Entity type:Organization
Organization Name:DEJA VU HEALING HEARTS ADULT DAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JANILA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-978-9268
Mailing Address - Street 1:4215 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2422
Mailing Address - Country:US
Mailing Address - Phone:314-882-9332
Mailing Address - Fax:314-925-8180
Practice Address - Street 1:4215 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2422
Practice Address - Country:US
Practice Address - Phone:314-882-9332
Practice Address - Fax:314-925-8180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care