Healthcare Provider Details

I. General information

NPI: 1962208140
Provider Name (Legal Business Name): EASTERN ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 HOLLAND RD
SUFFOLK VA
23434-6517
US

IV. Provider business mailing address

1514 HOLLAND RD
SUFFOLK VA
23434-6517
US

V. Phone/Fax

Practice location:
  • Phone: 757-291-7272
  • Fax:
Mailing address:
  • Phone: 757-291-7272
  • 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: LATONYA BUTLER
Title or Position: CEO
Credential:
Phone: 757-291-7272