Healthcare Provider Details

I. General information

NPI: 1265804256
Provider Name (Legal Business Name): CAMBRIDGE ADULT DAY CENTER-DEXTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W OAK ST
DEXTER MO
63841-1021
US

IV. Provider business mailing address

812 W OAK ST
DEXTER MO
63841-1021
US

V. Phone/Fax

Practice location:
  • Phone: 573-614-5788
  • Fax: 573-614-5782
Mailing address:
  • Phone: 573-614-5788
  • Fax: 573-614-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1280
License Number StateMO

VIII. Authorized Official

Name: LUCINDA GYURCI
Title or Position: MANAGING PARTNER
Credential:
Phone: 573-614-5788