Provider Demographics
NPI:1376712455
Name:MADIE ENTERPRISE INC DBA OLD YALE ADULT DAY CARE
Entity Type:Organization
Organization Name:MADIE ENTERPRISE INC DBA OLD YALE ADULT DAY CARE
Other - Org Name:OLD YALE ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:GAYLON
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-695-6100
Mailing Address - Street 1:4414 OLD YALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-4506
Mailing Address - Country:US
Mailing Address - Phone:713-695-6100
Mailing Address - Fax:713-695-6349
Practice Address - Street 1:4414 OLD YALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-4506
Practice Address - Country:US
Practice Address - Phone:713-695-6100
Practice Address - Fax:713-695-6349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADIE ENTERPRISE INC DBA OLD YALE ADULT DAY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125917OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES