Provider Demographics
NPI:1144395971
Name:BEST FRIENDS ADULT ACTIVITY CENTER INC
Entity Type:Organization
Organization Name:BEST FRIENDS ADULT ACTIVITY CENTER INC
Other - Org Name:BEST FRIENDS ADULT ACTIVITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-753-1795
Mailing Address - Street 1:503 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-7536
Mailing Address - Country:US
Mailing Address - Phone:903-753-1795
Mailing Address - Fax:
Practice Address - Street 1:503 S GREEN ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7536
Practice Address - Country:US
Practice Address - Phone:903-753-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-08-04
Deactivation Date:2008-01-09
Deactivation Code:
Reactivation Date:2014-08-04
Provider Licenses
StateLicense IDTaxonomies
TX001526261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000874Medicaid