Healthcare Provider Details

I. General information

NPI: 1053588459
Provider Name (Legal Business Name): TAMAQUA AREA ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BROAD ST
TAMAQUA PA
18252-1821
US

IV. Provider business mailing address

300 W BROAD ST P.O. BOX 485
TAMAQUA PA
18252-1821
US

V. Phone/Fax

Practice location:
  • Phone: 570-668-6556
  • Fax: 570-668-2248
Mailing address:
  • Phone: 570-668-6556
  • Fax: 570-668-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number000401580
License Number StatePA

VIII. Authorized Official

Name: MRS. DEBORAH A SHIPE
Title or Position: FACILITY DIRECTOR
Credential: LPN
Phone: 570-668-6556