Healthcare Provider Details

I. General information

NPI: 1811070485
Provider Name (Legal Business Name): ABILENE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 S 7TH ST
ABILENE TX
79605-2818
US

IV. Provider business mailing address

3518 S 7TH ST
ABILENE TX
79605-2818
US

V. Phone/Fax

Practice location:
  • Phone: 325-672-5742
  • Fax: 325-672-5135
Mailing address:
  • Phone: 325-672-5742
  • Fax: 325-672-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number116368
License Number StateTX

VIII. Authorized Official

Name: LISA CORNWELL
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 325-672-5742