Healthcare Provider Details

I. General information

NPI: 1851780480
Provider Name (Legal Business Name): CAMBRIDGE ADULT DAY CENTER-THAYER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 3 BOX 3439
THAYER MO
65791-9304
US

IV. Provider business mailing address

RR 3 BOX 3439
THAYER MO
65791-9304
US

V. Phone/Fax

Practice location:
  • Phone: 417-264-2951
  • Fax:
Mailing address:
  • Phone: 417-264-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1228
License Number StateMO

VIII. Authorized Official

Name: MS. DIANNA LEE BIRD
Title or Position: PROGRAM MANAGER
Credential:
Phone: 417-264-2951