Healthcare Provider Details

I. General information

NPI: 1265082580
Provider Name (Legal Business Name): ALL DAY ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N4901 DAM RD
DELAVAN WI
53115-2927
US

IV. Provider business mailing address

N4901 DAM RD
DELAVAN WI
53115-2927
US

V. Phone/Fax

Practice location:
  • Phone: 262-326-2545
  • Fax: 262-317-9673
Mailing address:
  • Phone: 262-326-2545
  • Fax: 262-317-9673

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: MR. JOHN JACOBSON
Title or Position: MANAGER
Credential: PTA
Phone: 262-326-2545