Provider Demographics
NPI:1609991413
Name:J-LYDASH INC DBA MESQUITE ADULT DAY ACTIVITIES HEALTH CENTER
Entity Type:Organization
Organization Name:J-LYDASH INC DBA MESQUITE ADULT DAY ACTIVITIES HEALTH CENTER
Other - Org Name:MESQUITE ADULT DAY ACTIVITIES HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:972-226-2131
Mailing Address - Street 1:229 BARNES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3103
Mailing Address - Country:US
Mailing Address - Phone:972-226-2131
Mailing Address - Fax:972-226-9054
Practice Address - Street 1:229 BARNES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3103
Practice Address - Country:US
Practice Address - Phone:972-226-2131
Practice Address - Fax:972-226-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117674261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care