Healthcare Provider Details

I. General information

NPI: 1992965040
Provider Name (Legal Business Name): ACTIVE DAY IN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 MEZZANINE DRIVE
LAFAYETTE IN
47905
US

IV. Provider business mailing address

3922 MEZZANINE DRIVE
LAFAYETTE IN
47905
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-7128
  • Fax:
Mailing address:
  • Phone: 765-446-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRIS W BALDOCK
Title or Position: CEO PRESIDENT
Credential:
Phone: 443-548-2200