Healthcare Provider Details

I. General information

NPI: 1316620867
Provider Name (Legal Business Name): DYNAMIC ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 E 86TH TER
RAYTOWN MO
64138-5154
US

IV. Provider business mailing address

6222 RAYTOWN TRFY # 244
RAYTOWN MO
64133-3847
US

V. Phone/Fax

Practice location:
  • Phone: 816-237-9373
  • Fax:
Mailing address:
  • Phone: 816-237-9373
  • 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: MARY JONES
Title or Position: PRESIDENT
Credential:
Phone: 816-237-9373