Healthcare Provider Details

I. General information

NPI: 1063269066
Provider Name (Legal Business Name): EXTENDED FAMILY ADULT DAY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TRACY RD
NEW WHITELAND IN
46184-1024
US

IV. Provider business mailing address

210 TRACY RD
NEW WHITELAND IN
46184-1024
US

V. Phone/Fax

Practice location:
  • Phone: 317-530-2395
  • Fax:
Mailing address:
  • Phone: 317-530-2395
  • Fax:

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: MEGAN SMITH
Title or Position: OWNER
Credential:
Phone: 317-626-4609