MEDICARE: JEFFERSON COUNTY ADULT DAY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1083945810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON COUNTY ADULT DAY CENTER

Provider Business Mailing Address
First Line	:	236 DRYDEN PL
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-8315
Country	:	US
Telephone Number	:	409-549-6260
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 5TH ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-6540
Country	:	US
Telephone Number	:	409-549-6260
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SCHWANNA K. JOHNSON
Credential	:	RN
Telephone Number	:	409-225-6475

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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Directions to “JEFFERSON COUNTY ADULT DAY CENTER ” Practice Location

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