Provider Demographics
NPI:1225450141
Name:DIA-ZZZ-LY ADULT DAY CARE
Entity Type:Organization
Organization Name:DIA-ZZZ-LY ADULT DAY CARE
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEPRTA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:817-704-8018
Mailing Address - Street 1:4805 ARABIAN CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-2451
Mailing Address - Country:US
Mailing Address - Phone:817-704-8018
Mailing Address - Fax:
Practice Address - Street 1:4805 ARABIAN CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-2451
Practice Address - Country:US
Practice Address - Phone:817-704-8018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-11
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherPRIVATE PAY AND MEDICAID