Provider Demographics
NPI:1275955080
Name:CACHE VALLEY ADULT DAY CENTER, INC.
Entity Type:Organization
Organization Name:CACHE VALLEY ADULT DAY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-0400
Mailing Address - Street 1:1488 N 200 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6842
Mailing Address - Country:US
Mailing Address - Phone:435-753-0400
Mailing Address - Fax:435-753-1853
Practice Address - Street 1:1488 N 200 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6842
Practice Address - Country:US
Practice Address - Phone:435-753-0400
Practice Address - Fax:435-753-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2969385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care