=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518154608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANISSA LONG DBA A PLEASANT DAY ADULT DAY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2007
-----------------------------------------------------
Last Update Date | 07/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 S PORTER AVE
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-206-4064
-----------------------------------------------------
Fax | 417-206-4064
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1231 S PORTER AVE
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-206-4064
-----------------------------------------------------
Fax | 417-206-4064
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN DIRECTOR OWNER
-----------------------------------------------------
Name | ANISSA LEE LONG
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 417-206-4064
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 722
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------