Provider Demographics
NPI:1639544919
Name:ADULT DAY HEALTH, INC.
Entity Type:Organization
Organization Name:ADULT DAY HEALTH, INC.
Other - Org Name:RENAISSANCE ADULT DAY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP QI
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDD-GARCELON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-733-2552
Mailing Address - Street 1:225 FOXBOROUGH BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-3062
Mailing Address - Country:US
Mailing Address - Phone:508-733-2552
Mailing Address - Fax:774-215-5708
Practice Address - Street 1:1040 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2235
Practice Address - Country:US
Practice Address - Phone:508-925-0389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100665JMedicaid