Provider Demographics
NPI:1851780480
Name:CAMBRIDGE ADULT DAY CENTER-THAYER LLC
Entity Type:Organization
Organization Name:CAMBRIDGE ADULT DAY CENTER-THAYER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-264-2951
Mailing Address - Street 1:RR 3 BOX 3439
Mailing Address - Street 2:
Mailing Address - City:THAYER
Mailing Address - State:MO
Mailing Address - Zip Code:65791-9304
Mailing Address - Country:US
Mailing Address - Phone:417-264-2951
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 3439
Practice Address - Street 2:
Practice Address - City:THAYER
Practice Address - State:MO
Practice Address - Zip Code:65791-9304
Practice Address - Country:US
Practice Address - Phone:417-264-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1228261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26Medicaid