Provider Demographics
NPI:1083945810
Name:JEFFERSON COUNTY ADULT DAY CENTER
Entity Type:Organization
Organization Name:JEFFERSON COUNTY ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHWANNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:409-225-6475
Mailing Address - Street 1:236 DRYDEN PL
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8315
Mailing Address - Country:US
Mailing Address - Phone:409-549-6260
Mailing Address - Fax:
Practice Address - Street 1:603 5TH ST
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-6540
Practice Address - Country:US
Practice Address - Phone:409-549-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility