Healthcare Provider Details

I. General information

NPI: 1184745853
Provider Name (Legal Business Name): SLIDELL ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2768 SGT ALFRED DR
SLIDELL LA
70458-4014
US

IV. Provider business mailing address

2768 SGT ALFRED DR
SLIDELL LA
70458-4014
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-1112
  • Fax: 985-643-3444
Mailing address:
  • Phone: 985-643-1112
  • Fax: 985-643-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberADHC 5001
License Number StateLA

VIII. Authorized Official

Name: DWIGHT ERIC DENHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 985-643-1112