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General NPI Number Information
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NPI Number | 1114100609
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Entity Type | Organization
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Legal Business Name | COMMUNITY ADULT DAY ACTIVITY & HEALTH CENTER
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 1305 S WASHINGTON AVE
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City | MARSHALL
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State | TX
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Zip | 75670-6215
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Country | US
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Telephone | 903-935-1610
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Fax | 903-935-8024
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Provider Business Mailing Address
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Address Line | 1305 S. WASHINGTON AVE.
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City | MARSHALL
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State | TX
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Zip | 75670-6215
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Country | US
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Telephone | 903-935-1610
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Fax | 903-935-8024
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MELBA JONES
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Credential | RN
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Telephone | 903-935-1610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 120391
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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