Provider Demographics
NPI:1114771920
Name:THE RAY DAE
Entity Type:Organization
Organization Name:THE RAY DAE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SDP, CHC
Authorized Official - Phone:479-715-3875
Mailing Address - Street 1:701 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-2871
Mailing Address - Country:US
Mailing Address - Phone:479-715-3875
Mailing Address - Fax:
Practice Address - Street 1:701 MADISON DR
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-2871
Practice Address - Country:US
Practice Address - Phone:479-715-3875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health