Provider Demographics
NPI:1417257304
Name:MAKE MY DAY ADULT DAY CARE,LLC
Entity Type:Organization
Organization Name:MAKE MY DAY ADULT DAY CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIDL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-458-0622
Mailing Address - Street 1:534 SE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1631
Mailing Address - Country:US
Mailing Address - Phone:239-458-0622
Mailing Address - Fax:239-458-2885
Practice Address - Street 1:534 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1631
Practice Address - Country:US
Practice Address - Phone:239-458-0622
Practice Address - Fax:239-458-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9122261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002087300Medicaid