Provider Demographics
NPI:1659555738
Name:NORTHSIDE ADULT DAYCARE CENTER, INC.
Entity Type:Organization
Organization Name:NORTHSIDE ADULT DAYCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:817-740-1611
Mailing Address - Street 1:1401 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-9143
Mailing Address - Country:US
Mailing Address - Phone:817-740-1611
Mailing Address - Fax:817-740-1667
Practice Address - Street 1:1401 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76106
Practice Address - Country:US
Practice Address - Phone:817-740-1611
Practice Address - Fax:817-740-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care