Provider Demographics
NPI:1275245433
Name:SEASONED ADULT DAY CARE, INC
Entity Type:Organization
Organization Name:SEASONED ADULT DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-651-9254
Mailing Address - Street 1:1016 LESLIE ANN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2208
Mailing Address - Country:US
Mailing Address - Phone:804-651-9254
Mailing Address - Fax:
Practice Address - Street 1:813 W NINE MILE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1124
Practice Address - Country:US
Practice Address - Phone:804-651-9254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care