Provider Demographics
NPI:1518154608
Name:ANISSA LONG DBA A PLEASANT DAY ADULT DAY CENTER
Entity Type:Organization
Organization Name:ANISSA LONG DBA A PLEASANT DAY ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:417-206-4064
Mailing Address - Street 1:1231 S PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801
Mailing Address - Country:US
Mailing Address - Phone:417-206-4064
Mailing Address - Fax:417-206-4064
Practice Address - Street 1:1231 S PORTER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801
Practice Address - Country:US
Practice Address - Phone:417-206-4064
Practice Address - Fax:417-206-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO722261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO296350705Medicaid