1497186704 NPI number — ADULT DAY SERVICES, INC.

Table of content: (NPI 1497186704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497186704 NPI number — ADULT DAY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT DAY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WALKER ADULT DAY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497186704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 CARR LK RD SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEMIDJI
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-751-1324
Provider Business Mailing Address Fax Number:
218-444-5324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 CARR LK RD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEMIDJI
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-751-1324
Provider Business Practice Location Address Fax Number:
218-444-5324
Provider Enumeration Date:
12/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
COLLMAN
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
218-751-1324

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  1022091-3-ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302R00000X , with the licence number: 1054266-ADC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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