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General NPI Number Information
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NPI Number | 1417257304
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Entity Type | Organization
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Legal Business Name | MAKE MY DAY ADULT DAY CARE,LLC
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 534 SE 16TH PL
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City | CAPE CORAL
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State | FL
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Zip | 33990-1631
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Country | US
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Telephone | 239-458-0622
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Fax | 239-458-2885
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Provider Business Mailing Address
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Address Line | 534 SE 16TH PL
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City | CAPE CORAL
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State | FL
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Zip | 33990-1631
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Country | US
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Telephone | 239-458-0622
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Fax | 239-458-2885
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Authorized Official
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Title or Position | CEO
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Name | MR. GERHARD KEIDL
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Credential |
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Telephone | 239-458-0622
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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 | 9122
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License Number State | FL
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