Healthcare Provider Details

I. General information

NPI: 1164798047
Provider Name (Legal Business Name): AFFINITY ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18813 E 25TH ST S
INDEPENDENCE MO
64057-2467
US

IV. Provider business mailing address

8540 BLUERIDGE
RAYTOWN MO
64138-2959
US

V. Phone/Fax

Practice location:
  • Phone: 816-898-7529
  • Fax:
Mailing address:
  • Phone: 816-759-0112
  • 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: PATRICE DUMAS VERAGUTH
Title or Position: ADMINISTRATOR
Credential:
Phone: 816-759-0112