Provider Demographics
NPI:1063554780
Name:LOVINGADULTDAYCARECENTER,INC.
Entity type:Organization
Organization Name:LOVINGADULTDAYCARECENTER,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAN DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-758-3001
Mailing Address - Street 1:1560 W WHEELER
Mailing Address - Street 2:STE E
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4556
Mailing Address - Country:US
Mailing Address - Phone:361-758-3001
Mailing Address - Fax:361-758-5381
Practice Address - Street 1:1560 W WHEELER
Practice Address - Street 2:STE E
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4556
Practice Address - Country:US
Practice Address - Phone:361-758-3001
Practice Address - Fax:361-758-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-17
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-06-17
Provider Licenses
StateLicense IDTaxonomies
TX7428273360171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty