Provider Demographics
NPI:1366899809
Name:FAMILY ADULT DAY CARE
Entity type:Organization
Organization Name:FAMILY ADULT DAY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUME
Authorized Official - Suffix:
Authorized Official - Credentials:RN/RDH
Authorized Official - Phone:860-436-2013
Mailing Address - Street 1:445A WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2318
Mailing Address - Country:US
Mailing Address - Phone:860-436-2013
Mailing Address - Fax:
Practice Address - Street 1:445A WILLARD AVE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2318
Practice Address - Country:US
Practice Address - Phone:860-436-2013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HOME CARE ASSISTANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care