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General NPI Number Information
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NPI Number | 1669903852
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Entity Type | Organization
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Legal Business Name | MODESTO ADULT DAY PROGRAM PARTNERS
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 3217 TULLY RD
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City | MODESTO
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State | CA
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Zip | 95350-0832
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Country | US
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Telephone | 209-622-0963
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Fax | 209-661-4903
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Provider Business Mailing Address
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Address Line | 3217 TULLY RD
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City | MODESTO
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State | CA
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Zip | 95350-0832
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Country | US
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Telephone | 209-622-0963
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Fax | 209-661-4903
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Authorized Official
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Title or Position | GENERAL PARTNER/ADMINISTRATOR
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Name | MR. RUSSELL N MILNES
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Credential |
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Telephone | 209-622-0963
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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 | 502700147
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License Number State | CA
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