Healthcare Provider Details

I. General information

NPI: 1790956225
Provider Name (Legal Business Name): ACTIVE DAY IN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W KILGORE AVE SUITE 5
YORKTOWN IN
47396-9290
US

IV. Provider business mailing address

7701 W KILGORE AVE SUITE 5
YORKTOWN IN
47396-9290
US

V. Phone/Fax

Practice location:
  • Phone: 765-759-3851
  • Fax:
Mailing address:
  • Phone: 765-759-3851
  • 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: MR. KRIS W BALDOCK
Title or Position: CEO, PRESIDENT/CHAIRMAN OF THE BOAR
Credential:
Phone: 443-548-2200