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General NPI Number Information
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NPI Number | 1780049569
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE ADULT DAY CENTER POPLAR BLUFF, LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 2162 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2440
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Country | US
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Telephone | 573-609-2190
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Fax |
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Provider Business Mailing Address
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Address Line | 2162 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2440
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Country | US
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Telephone | 573-609-2190
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Fax | 573-609-2302
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | JAMES LYLE
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Credential |
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Telephone | 314-795-8677
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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 | 1301
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License Number State | MO
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