=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457558736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULT DAY & RESPITE CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 07/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3107 GROOMETOWN RD 5026- F HILLTOP RD
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-5518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-852-8338
-----------------------------------------------------
Fax | 336-852-8333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3107 GROOMETOWN RD N-A
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-5518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-852-8338
-----------------------------------------------------
Fax | 336-852-8333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. JOANNE CAGLE
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 336-852-8338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number | 3409220
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------