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General NPI Number Information
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NPI Number | 1235471368
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Entity Type | Organization
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Legal Business Name | YOUR SECOND HOME ADULT DAY CARE INC.
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 3702 N COURTENAY PKWY SUITE 108/110
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-8155
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Country | US
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Telephone | 321-986-8500
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Fax | 321-986-8444
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Provider Business Mailing Address
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Address Line | 3702 N COURTENAY PKWY SUITE 108/110
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-8155
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Country | US
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Telephone | 321-986-8500
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Fax | 321-986-8444
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Authorized Official
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Title or Position | ADMINISTRATOR & OWNER
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Name | MRS. GANGADAI SINGH DOODNAUTH
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Credential |
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Telephone | 321-986-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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