Provider Demographics
NPI:1053588459
Name:TAMAQUA AREA ADULT DAY CARE CENTER
Entity type:Organization
Organization Name:TAMAQUA AREA ADULT DAY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:570-668-6556
Mailing Address - Street 1:300 W BROAD ST
Mailing Address - Street 2:P.O. BOX 485
Mailing Address - City:TAMAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18252-1821
Mailing Address - Country:US
Mailing Address - Phone:570-668-6556
Mailing Address - Fax:570-668-2248
Practice Address - Street 1:300 W BROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1821
Practice Address - Country:US
Practice Address - Phone:570-668-6556
Practice Address - Fax:570-668-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000401580261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care