Provider Demographics
NPI:1215163761
Name:KELLY'S ADULT DAY CARE CENTER, INC.
Entity type:Organization
Organization Name:KELLY'S ADULT DAY CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-698-2611
Mailing Address - Street 1:2000 RAULSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1432
Mailing Address - Country:US
Mailing Address - Phone:423-698-2611
Mailing Address - Fax:423-698-2911
Practice Address - Street 1:2000 RAULSTON ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1432
Practice Address - Country:US
Practice Address - Phone:423-698-2611
Practice Address - Fax:423-698-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-25A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care