Provider Demographics
NPI:1376872135
Name:CLASSIC CARE ADULT DAY CARE
Entity Type:Organization
Organization Name:CLASSIC CARE ADULT DAY CARE
Other - Org Name:CLASSIC CARE ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-794-1811
Mailing Address - Street 1:509 N DOWNING RD STE B
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3944
Mailing Address - Country:US
Mailing Address - Phone:979-549-0830
Mailing Address - Fax:
Practice Address - Street 1:509 N DOWNING STE. B
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-549-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103321251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103321OtherFACILITY ID NUMBER