1750795480 NPI number — WHAT A DAY ADULT DAYCARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750795480 NPI number — WHAT A DAY ADULT DAYCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHAT A DAY ADULT DAYCARE
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:
Provider Other Organization Name Type Code:
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:
1750795480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177 COLLEGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30236-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-996-0775
Provider Business Mailing Address Fax Number:
770-478-2501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-996-0775
Provider Business Practice Location Address Fax Number:
770-478-2501
Provider Enumeration Date:
06/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MALLORY
Authorized Official First Name:
KAMILL
Authorized Official Middle Name:
ALEAHA
Authorized Official Title or Position:
CO-DIRECTOR
Authorized Official Telephone Number:
770-996-0775

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00967359A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00967359B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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