Provider Demographics
NPI:1063269066
Name:EXTENDED FAMILY ADULT DAY SERVICES INC
Entity type:Organization
Organization Name:EXTENDED FAMILY ADULT DAY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-626-4609
Mailing Address - Street 1:210 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:NEW WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1024
Mailing Address - Country:US
Mailing Address - Phone:317-530-2395
Mailing Address - Fax:
Practice Address - Street 1:210 TRACY RD
Practice Address - Street 2:
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1024
Practice Address - Country:US
Practice Address - Phone:317-530-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care