Healthcare Provider Details

I. General information

NPI: 1225319056
Provider Name (Legal Business Name): INDIANA ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 WAYNE AVE
INDIANA PA
15701-3514
US

IV. Provider business mailing address

209 SIGMA DR
PITTSBURGH PA
15238-2826
US

V. Phone/Fax

Practice location:
  • Phone: 724-464-2273
  • Fax:
Mailing address:
  • Phone: 412-963-9150
  • Fax: 412-963-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number054990
License Number StatePA

VIII. Authorized Official

Name: MR. HERBERT H HENNELL
Title or Position: DIR. OF REIMBURSEMENT
Credential:
Phone: 412-963-9150