Provider Demographics
NPI:1730215278
Name:KIRBY ADULT DAY CARE, INC.
Entity type:Organization
Organization Name:KIRBY ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HYSAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-310-1602
Mailing Address - Street 1:5135 SEGUIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-1095
Mailing Address - Country:US
Mailing Address - Phone:210-310-1602
Mailing Address - Fax:210-310-1602
Practice Address - Street 1:5135 SEGUIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-1095
Practice Address - Country:US
Practice Address - Phone:210-310-1602
Practice Address - Fax:210-310-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001728OtherCONTRACT NUMBER