Provider Demographics
NPI:1083346969
Name:LOYAL ADULY DAYCARE
Entity Type:Organization
Organization Name:LOYAL ADULY DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-345-4286
Mailing Address - Street 1:3055 OLD HIGHWAY 8 STE 103
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2591
Mailing Address - Country:US
Mailing Address - Phone:612-345-4286
Mailing Address - Fax:612-259-8440
Practice Address - Street 1:3055 OLD HIGHWAY 8 STE 103
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2591
Practice Address - Country:US
Practice Address - Phone:612-345-4286
Practice Address - Fax:612-259-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty