Provider Demographics
NPI:1689109118
Name:AMAZING ADULT DAY LLC
Entity Type:Organization
Organization Name:AMAZING ADULT DAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODNIKA
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-598-7402
Mailing Address - Street 1:3149 COMMERCE CENTER PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1975
Mailing Address - Country:US
Mailing Address - Phone:502-774-3337
Mailing Address - Fax:
Practice Address - Street 1:832 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2124
Practice Address - Country:US
Practice Address - Phone:502-774-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750194311500000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)