Healthcare Provider Details

I. General information

NPI: 1235471368
Provider Name (Legal Business Name): YOUR SECOND HOME ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 N COURTENAY PKWY SUITE 108/110
MERRITT ISLAND FL
32953-8155
US

IV. Provider business mailing address

3702 N COURTENAY PKWY SUITE 108/110
MERRITT ISLAND FL
32953-8155
US

V. Phone/Fax

Practice location:
  • Phone: 321-986-8500
  • Fax: 321-986-8444
Mailing address:
  • Phone: 321-986-8500
  • Fax: 321-986-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. GANGADAI SINGH DOODNAUTH
Title or Position: ADMINISTRATOR & OWNER
Credential:
Phone: 321-986-8500