Provider Demographics
NPI:1316620867
Name:DYNAMIC ADULT DAYCARE INC
Entity type:Organization
Organization Name:DYNAMIC ADULT DAYCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-237-9373
Mailing Address - Street 1:6222 RAYTOWN TRFY # 244
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3847
Mailing Address - Country:US
Mailing Address - Phone:816-237-9373
Mailing Address - Fax:
Practice Address - Street 1:11800 E 86TH TER
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-5154
Practice Address - Country:US
Practice Address - Phone:816-237-9373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care