Provider Demographics
NPI:1124306865
Name:ADULT DAY&RESPITE CARE CENTER
Entity type:Organization
Organization Name:ADULT DAY&RESPITE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:336-852-8338
Mailing Address - Street 1:3107 GROOMETOWN RD
Mailing Address - Street 2:N/A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5518
Mailing Address - Country:US
Mailing Address - Phone:336-852-8338
Mailing Address - Fax:336-852-8333
Practice Address - Street 1:3107 GROOMETOWN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5518
Practice Address - Country:US
Practice Address - Phone:336-852-8338
Practice Address - Fax:336-852-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-076-099261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409220Medicaid