Provider Demographics
NPI:1346617602
Name:CAMBRIDGE ADULT DAY CENTER SPRINGFIELD
Entity Type:Organization
Organization Name:CAMBRIDGE ADULT DAY CENTER SPRINGFIELD
Other - Org Name:CAMBRIDGE ADULT DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CORNIO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:417-865-3115
Mailing Address - Street 1:2221 E KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-4987
Mailing Address - Country:US
Mailing Address - Phone:417-865-3115
Mailing Address - Fax:417-865-3116
Practice Address - Street 1:2221 E KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4987
Practice Address - Country:US
Practice Address - Phone:417-865-3115
Practice Address - Fax:417-865-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1275261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care