1396242459 NPI number — FRIENDSHIP ADULT DAY CARE CENTER, INC.

Table of content: INDIA DENISE DAVIS NONE (NPI 1467119677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396242459 NPI number — FRIENDSHIP ADULT DAY CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIENDSHIP ADULT DAY CARE CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1396242459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 EUCALYPTUS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93108-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-969-0859
Provider Business Mailing Address Fax Number:
805-565-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 N FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93117-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-969-0859
Provider Business Practice Location Address Fax Number:
805-565-3828
Provider Enumeration Date:
04/06/2018

Additional Information

Authorized Official

Authorized Official Last Name:
COHN
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
805-969-0859

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  425801731 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 425801731 . This is a "COMMUNITY CARE LICENSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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