Provider Demographics
NPI:1033566997
Name:PREMIER ADULT DAY SERVICE
Entity Type:Organization
Organization Name:PREMIER ADULT DAY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-227-6612
Mailing Address - Street 1:1467 JOLIET ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2090
Mailing Address - Country:US
Mailing Address - Phone:219-227-6612
Mailing Address - Fax:219-227-6611
Practice Address - Street 1:1467 JOLIET ST
Practice Address - Street 2:SUITE D
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2090
Practice Address - Country:US
Practice Address - Phone:219-227-6612
Practice Address - Fax:219-227-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health