1184022824 NPI number — FRIENDS AND FAMILY ADULT DAY PROGRAM, LLC

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 1184022824 NPI number — FRIENDS AND FAMILY ADULT DAY PROGRAM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIENDS AND FAMILY ADULT DAY PROGRAM, LLC
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:
1184022824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 KIMBALL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-473-6334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4327 ALBANY POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12538-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-229-2851
Provider Business Practice Location Address Fax Number:
845-229-2543
Provider Enumeration Date:
12/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MCCALLA
Authorized Official First Name:
SHERMAN
Authorized Official Middle Name:
DENNIS
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICDER
Authorized Official Telephone Number:
845-473-6334

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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