Healthcare Provider Details

I. General information

NPI: 1114100609
Provider Name (Legal Business Name): COMMUNITY ADULT DAY ACTIVITY & HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S WASHINGTON AVE
MARSHALL TX
75670-6215
US

IV. Provider business mailing address

1305 S. WASHINGTON AVE.
MARSHALL TX
75670-6215
US

V. Phone/Fax

Practice location:
  • Phone: 903-935-1610
  • Fax: 903-935-8024
Mailing address:
  • Phone: 903-935-1610
  • Fax: 903-935-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number120391
License Number StateTX

VIII. Authorized Official

Name: MS. MELBA JONES
Title or Position: DIRECTOR
Credential: RN
Phone: 903-935-1610