Provider Demographics
NPI:1386044170
Name:HAMPTON ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:HAMPTON ADULT DAY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:WESTNORELAND
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:229-344-2499
Mailing Address - Street 1:1122 W WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-4834
Mailing Address - Country:US
Mailing Address - Phone:229-299-4624
Mailing Address - Fax:229-375-0536
Practice Address - Street 1:1122 W WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4834
Practice Address - Country:US
Practice Address - Phone:229-299-4624
Practice Address - Fax:229-375-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA590Medicaid