Provider Demographics
NPI:1659856599
Name:LADYSMITH ADULT DAY SERVICES
Entity Type:Organization
Organization Name:LADYSMITH ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:CHERISMA
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-532-4000
Mailing Address - Street 1:518 LAKE AVE W
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1210
Mailing Address - Country:US
Mailing Address - Phone:715-532-4000
Mailing Address - Fax:715-609-1444
Practice Address - Street 1:518 LAKE AVE W
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1210
Practice Address - Country:US
Practice Address - Phone:715-532-4000
Practice Address - Fax:715-609-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care