Northern Family Adult Daycare LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

NORTHERN FAMILY ADULT DAYCARE LLC

Practice address

11763 Benham Rd
Saint Louis, MO 63136-6113

Phone

(314) 308-9106

NPI assigned

Aug 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Etis Northern

Title

Director

Phone

(314) 308-9106

Specialties & licenses 1

Addresses

Other names 1

• Saint Louis Other name

Electronic endpoints 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1760156913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11763 BENHAM RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366113",
            "telephone_number": "314-308-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11763 BENHAM RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366113",
            "telephone_number": "314-308-9106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN FAMILY ADULT DAYCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "NORTHERN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ETIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "314-308-9106"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kim@northernfamilycares.com",
            "affiliation": "N",
            "endpointDescription": "kim@northernfamilycares.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kim@northernfamilycares.com",
            "address_1": "11763 Benham Rd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kim@northernfamilycares.com",
            "affiliation": "N",
            "endpointDescription": "kim@northernfamilycares.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kim@northernfamilycares.com",
            "address_1": "11763 Benham Rd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631366113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Saint Louis",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Adult Day Care Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Adult Day Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.