Provider Demographics
NPI:1861835498
Name:SHUFFETT'S ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:SHUFFETT'S ADULT DAY CARE, INC.
Other - Org Name:EDMONTON ADULT DAY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:SHUFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:BS BUSINESS/ACCOUNTI
Authorized Official - Phone:270-432-3851
Mailing Address - Street 1:104 HILL ST
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-9412
Mailing Address - Country:US
Mailing Address - Phone:270-432-3851
Mailing Address - Fax:270-432-5673
Practice Address - Street 1:104 HILL ST
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-9412
Practice Address - Country:US
Practice Address - Phone:270-432-3851
Practice Address - Fax:270-432-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY750111261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care