Healthcare Provider Details

I. General information

NPI: 1194099176
Provider Name (Legal Business Name): WELL KEPT ADULT DAYCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 WASHINGTON AVE
WELDON NC
27890-1548
US

IV. Provider business mailing address

216 WASHINGTON AVE
WELDON NC
27890-1548
US

V. Phone/Fax

Practice location:
  • Phone: 252-536-0383
  • Fax:
Mailing address:
  • Phone: 252-536-0383
  • 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: MRS. TRACEY MICHELLE BOYCE
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 252-536-0383