Provider Demographics
NPI:1750400495
Name:ADULT DAY CARE CENTER OF MARTINSVILLE & HENRY COUNTY
Entity type:Organization
Organization Name:ADULT DAY CARE CENTER OF MARTINSVILLE & HENRY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WHITENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-666-9400
Mailing Address - Street 1:431 COMMONWEALTH BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2014
Mailing Address - Country:US
Mailing Address - Phone:276-666-9400
Mailing Address - Fax:
Practice Address - Street 1:431 COMMONWEALTH BOULEVARD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2014
Practice Address - Country:US
Practice Address - Phone:276-666-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
VARO-06-342261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008730261Medicaid